Registration - Brazos Analysis Seminar Fall 2018

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Email *

Full Name *

Affiliation: *

Position: *

Professor, More than 5 years since Ph.D.

Professor or Postdoc, 5 or fewer years since Ph.D.

Graduate Student

Undergraduate Student

Other:

Required

Planned Date of Arrival: *

YYYY

Planned Date of Departure: *

YYYY

Do you wish to apply for funding to cover housing?

Yes (Graduate students who are receiving financial support should expect to share a hotel room with another graduate student participant)

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If you are a graduate student applying for funding for housing, give the name of your preferred roommate.

Gender:

(This information is used for NSF reporting and will only be reported in aggregate form. Answers are optional, but if you are willing to provide the information it is helpful in justifying our efforts to encourage diversity in our final report to the NSF.)

Female

Male

Prefer not to say

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Ethnicity:

White (Not Hispanic, Not Latino)

White (Hispanic or Latino)

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

Prefer Not to Answer

Other:

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Do you have any requests or special needs regarding your attendance or accommodations at the workshop? Is there any thing else you would like to inform us about?

A copy of your responses will be emailed to the address you provided.

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