Click *HERE* for a PDF version of the program flyer.
Note: If you have problems with this form, please send an email to Michael Glover.
Please note: Fields marked with an asterisk are REQUIRED.
*Firstname *Lastname
*Mailing Address
Mailing Address Line 2 (optional)
*City *State (two-letter abbreviation) *Zipcode
*Email (please assure accuracy)
*Daytime phone (please include area code)
*Campus ASU UAF UALR OTHER *Registration Type Faculty Post Doc Graduate Student Undergraduate Student
*Attendee Type Speaker Poster Session Speaker and Poster Session Regular Attendee
*Special Dietary Needs None Vegetarian Vegan Diabetic Other
For "Other" dietary needs, please list/describe here:
*Smoking Non-smoking Smoking
Roommate preference (please list names here)
*Do you need special accomodations due to a handicap or disability? No Yes
If you do need special accomodations, please describe here: