Genomics Education Partnership Faculty June Alumni Workshop Registration Form

Workshops (Check all that apply) Steering Committee Meeting (June 8-9, 2018) Faculty Alumni Workshop (June 9-12, 2018) G-OnRamp Workshop (June 12-15, 2018)

Full Legal Name (as it appears on your government-issued ID) Badge Name (if different than above) Institution Email Address Mailing Address Address Line 2 City State Zip Code Cell Phone Number Business Phone Number Emergency Contact Name Emergency Contact Relationship Emergency Contact Phone Dietary Restrictions Other Restrictions

Do you need flight arrangements? Yes No

Note that Wilson will be available the afternoon of the 8^th and Chris will be available the afternoon of the 9^th (Day 1 of the Steering Committee Meeting and of the Faculty Alumni Workshop, respectively); if you would like to consult with them during the afternoon, choose a flight that gets you to St. Louis early in the day. Group activities will start with the reception at 5 pm on the starting day, June 8 for the Steering Committee and June 9 for the Faculty Alumni Workshop.

If yes, please provide your date of birth MM/DD/YYYY (required by airline) Departure City Desired Arrival Date Desired Arrival Time Desired Departure Date Desired Departure Time Destination City (if different than departure city above) Flight Seat Preference Additional Travel Information Frequent Flyer Number If Driving, Approximate Miles Washington University Arrival Date Washington University Departure Date

Gender: Male Female

Participants will be housed in a Washington University dormitory (suite with 4 singles, 2 shared bathrooms). If you would prefer a hotel-style room (single, private bath, 24-hr front desk), we can book a room for you in the Knight Center (also on campus, nearby), but will ask you to pay the difference, ~$75/night.

Room Washington University dormitory (suite with 4 singles, 2 shared bathrooms) Knight Center (GEP member will pay ~$75/night)

Additional Information & Special Housing Requests

Note: When you commit to attending a GEP Alumni Workshop by registering, we will purchase a round-trip coach air ticket for you. You will be consulted on the schedule prior to purchase; we will only purchase the ticket with your approval. Please respond within 24 hr when you are contacted for approval. Once purchased, these tickets, which are issued in your name, are non-refundable and cannot be transferred to another person. If you cancel your attendance at the workshop, we ask that you use the ticket for your own personal travel (dates and destination can be changed), and refund the cost of the ticket to Washington University. If you have any concerns about this policy, please consult with Dr. Elgin (selgin@wustl.edu).