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Freshwater Future Spring 2012 Climate Symposium, Buffalo, New York, May 10-11
17.
Copy of page: Registration
1.
Please provide the following contact information
(Required.)
Name:
*
Organization:
Address 1:
*
Address 2:
City/Town:
*
State/Province:
*
ZIP/Postal Code:
*
Country:
*
Email Address:
Phone Number:
*
2.
Will anyone else from your organization or community be joining you? If yes, please list their contact information below.
3.
In which Lake Basin do you reside?
Lake Superior
Lake Michigan
Lake Huron
Lake Erie
Lake Ontario
4.
How are you traveling to the Symposium?
I am flying.
I am driving.
I am taking a train.
Public Transportation
Other
5.
If you are flying, please tell us your airline, travel dates and times. If you are planning on applying for a scholarship, please call 231-838-9934 before making any flight plans.
6.
If you are driving, would you like to carpool? (highly recommended)
Yes
No, thanks.
7.
If you would like to carpool, where are you traveling from and when will you be traveling? (We will use this information to connect you to participants traveling from the same area.)
8.
Please list any dietary requirement.
Vegetarian
Vegan
Allergies (please specify below)
Other (please specify)
9.
Will you need a hotel room? Rooms will be provided by Freshwater Future at the Hampton Inn and Suites in downtown Buffalo for Thursday evening, May 10.
Yes, Thursday night
No thanks
10.
If you need a hotel room, do you have a preferred roommate?
11.
Will you be applying for a travel scholarship to attend the Symposium?
(Required.)
Yes
No
12.
If applying for a travel scholarship, please list the following:
Number of miles driving
Airfare
Amount of travel assistance requested
Total Request
13.
14. What type of work does your organization engage in?
14.
What climate adaptation work would you like to engage in?
15.
Do you plan to apply to Freshwater Future for a Climate Grant?
Yes
No
16.
If yes, we will send you materials to bring to the Climate Symposium that will help you to prepare a Climate Grant application.
There is a $25.00 registration fee for the Symposium. Scholarships are available. Please send a $25.00 check made out to Freshwater Future to:
Climate Symposium Registration
Freshwater Future
P.O. Box 2479
Petoskey, MI 49770
