Women and Science/Technology Policy Seminar
Registration Form
First Name
Last Name
School
Your Address at School
City
State
Zip Code
Phone
Email
Alternate Email
Your Permanent Address
City
State
Zip Code
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Relation
Emergency Contact Phone
Academic Year
Senior
Junior
Sophomore
Freshman
Major
Special Food Requests
Vegetarian
Vegan
Housing Request
I am not requesting conference housing.
Double Room
Triple Room
Name of Roommate Requested
Please send me a an invoice via Paypal
Comments
Those who cancel their registration in writing before 5 PM EST on December 29, 2007 will receive a full refund less a $25 administrative fee and the $40 non-refundable registration fee.
After that date no refunds will be made.
There is a $15 fee for returned checks.
By registering for the PLEN Women & Science/Technology Policy Seminar, I understand that I am responsible for paying the $40 non-refundable registration fee, program fee and housing fee (if applicable). I have read and understand PLEN’s registration and refund policies and agree to abide by them.
