| Full Name:
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*
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| University: |
*
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| Primary Phone:
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Ext: *
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| Alternate phone:
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Ext: *
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| Email:
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*
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| Confirm Email:
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*
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| Account Review Password |
| You must set a password so that you may access the registration review website. You will use this password with your email address to review the information you have submitted on this form including your workshop selections. Your password must be at least 6 characters long. |
| Password: |
* |
| Emergency Contact |
| Contact Name: |
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| Relationship: |
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| Emergency Phone: |
Ext:
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| Session Information |
Important:
Only workshops that have not been enrolled to capacity are listed. |
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Please register me for the following workshop in Session A: |
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Fri, 9:00-10:15
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| Please register me for the following workshop in Session B: |
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Fri, 10:30-11:45
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| Please register me for the following workshop in Session C: |
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Fri, 1:45-3:15
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| Please register me for the following workshop in Session D: |
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Fri, 3:30-4:45
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| Please register me for the following workshop in Session E: |
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Sat, 9:00-10:15
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| Please register me for the following workshop in Session F: |
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Sat, 10:30-11:45
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| Demographic Data |
To determine the degree to which members of diverse segments of the population are reached by this announcement, NASA requests the applicant to check the appropriate selections below. These data will be used for statistical purposes only. In accordance with Federal statutes and regulations, and with NASA policies, no person on the grounds of race, color, age, sex, or disability shall be excluded from participation in, denied the benefits of, or be subject to discrimination under any program or activity receiving financial funding from NASA.
**This area includes any of the original people of Hawaii, the U.S. Pacific Territories of Guam, American Samoa, and the Northern Marianas; the Republic of Palau; the Islands of Micronesia and Melanasia; and Philippines.
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| Personal Needs |
This information is requested so that you may be better accommodated during the Conference.
Special Dietary Needs:Vegetarian
Disabled:Yes No
Health Condition we need to be aware of:Yes No
If yes, please explain:
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| Travel Arrangements |
This information is requested so that you may be better accommodated during the Conference.
By what mode of travel will you arrive? Air Ground *
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If you would like to participate in the optional tour of the DC area on Thursday at noon, please select the check box. The cost that is associated with this optional tour is $25.00.
DC Tour
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| Talent Show |
I would like to participate in the optional talent show.
Please specify your talent:
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| Students Attending |
| Please specify the names of the students who will be accompanying you to the conference. *Remember that reimbursement is based on your method of transportation; that is, based on grant limitations, mileage reimbursement will be applied for six students if traveling by ground, and air fare reimbursement for four students if traveling by air. |
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Student Full Name |
Male |
Female |
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Room 1 |
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Room 2
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Room 3 |
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Room 4 |
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| Registration Fee Information |
- Faculty early registration, $100 (Oct 23 - Dec 14)
- Faculty late registration, $120 (after Dec 14)
- Registration fees include two hotel nights, meals provided during the conference, all conference activities (unless otherwise noted), conference bags, and transportation reimbursement as noted elsewhere, which applies to both students and faculty advisors.
- Payments must be received or postmarked by January 11, 2008, or a $50 late payment penalty will be deducted from the institution's travel reimbursement.
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| Payment Information |
Please note new payment information
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Please make all checks, money orders or purchase orders payable to:
PSTC-Academic Partnerships, L.L.C.
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Send All Payments To:
PSTC-Academic Partnerships, L.L.C.
P.O. Box 265
Selbyville, DE 19975
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| Reminder: Please indicate the names of the people covered by your payment by completing the payment voucher and submitting it with your payment. (Click here for the 2008 Payment Voucher form) |
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