Workshops (Select one)
Faculty TA Workshop, June 5-10, 2016
Faculty TA Workshop, January 3-8, 2017
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
All local costs (housing and meals) for the workshop are supported by grants for all participants. In addition, we have grant funding to cover travel for up to two participants from each new member school.
If you are in this group, fill out the travel section below.
Do you need flight arrangements?
Yes
No
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
Room
Additional Information & Special Housing Requests
Note: If we are purchasing a round-trip coach air ticket for you, then you are making a commitment to attend the GEP Workshop. You will be consulted on the schedule prior to purchase; we will only purchase the ticket with your 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 Ms. Judy Musick (jmusick@wustl.edu).