Permutation Patterns 2016 Registration Form

Note: This is a registration form only. Money (registration fees, banquet ticket cost, and dorm room charges if any) will be collected later.

Question Title

* 1. What is your contact information?

Name *

Institutional Affiliation *

Address *

Address 2

City/Town *

State/Province

ZIP/Postal Code

Country *

Email Address *

Question Title

* 2. What is your position?

Senior faculty or researcher

Junior faculty or researcher

Graduate student

Undergraduate student

Other (please specify)

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* 3. Do you intend to give a talk or present a poster at the conference?

Yes

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* 4. Would you like to stay at the Howard University dorms during the conference? (See dorm room pricing.)

Yes, and I would like to share a room.

Yes, but I would NOT like to share a room.

No, I plan to stay off-campus.

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* 5. How many nights accommodation will you need? (enter a number)

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* 6. If you would like to share a room (at the dorms or at a hotel), do you have any roommate requests?

Yes, I would like to request a specific roommate (see next question).

Yes, please add my name to the list of those looking for a roommate.

No, I don't plan to share a room.

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* 7. Name of roommate (if applicable; see previous question)?

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* 8. Would you like to attend the banquet on Thursday? (Estimated cost: $70)

Yes

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* 1. What is your contact information?

Question Title

* 2. What is your position?

Question Title

* 3. Do you intend to give a talk or present a poster at the conference?

Question Title

* 4. Would you like to stay at the Howard University dorms during the conference? (See dorm room pricing.)

Question Title

* 5. How many nights accommodation will you need? (enter a number)

Question Title

* 6. If you would like to share a room (at the dorms or at a hotel), do you have any roommate requests?

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* 7. Name of roommate (if applicable; see previous question)?

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* 8. Would you like to attend the banquet on Thursday? (Estimated cost: $70)

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* 9. Need extra banquet tickets? Enter the number of accompanying persons, if any.