Freshwater Future Fall 2012 Climate Symposium, Duluth, MN, October 12-13 Survey

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1. Please provide the following contact information

Name: *

Organization:

Address 1: *

Address 2:

City/Town: *

State/Province: *

ZIP/Postal Code: *

Country: *

Email Address:

Phone Number: *

There is a $25.00 registration fee for the symposium (scholarships are available). Checks should be made payable to Freshwater Future and mailed to:

Climate Symposium Registration
Freshwater Future
P.O. Box 2479
Petoskey, MI 49770

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2. Will you need a hotel room in Duluth? Rooms will be provided by Freshwater Future at the Inn on Lake Superior.

Yes, Thursday night

Yes, Thursday and Friday nights

Yes, Friday night only

No thanks

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3. If you need a hotel room, do you have a preferred roommate? (most rooms will be doubles)

Yes (please tell us their name below)

I need a single room

Other (please specify)

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4. Meals will be provided during the symposium. Please list any dietary requirements.

Vegetarian

Vegan

Allergies (please specify below)

Other (please specify)

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5. If you are driving to Duluth, would you like to carpool?

Yes, and I can take passenger(s)

Yes, I need a ride

No, thanks.

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6. If interested in carpooling, where are you traveling from and when will you be traveling? (We will use this information to connect you with others traveling from the same area).

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7. Travel scholarships are available to help cover transportation costs. Will you be applying for a travel scholarship?

Yes

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8. If applying for a travel scholarship, what is your mode of travel and estimated mileage?

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9. What type of work does your organization engage in? Please give us a general description, as well as a brief summary of some specific projects you've been involved in.

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10. Is your organization currently doing climate related work?

Yes

I'm not sure

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11. If you answered yes to question 10, please tell us a little about your climate related work.

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12. If you answered no to question 10, what kind of climate adaptation work would you like to engage in?

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13. What are one or two questions you are most interested in having answered during the workshop?

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14. Do you plan to apply for a Freshwater Future Climate Grant?

Yes