X Fields in red are required. Name Email Institution Department If relevant, please state your department X Affiliation -Select Affiliation- Faculty Staff Student Community Member Other (specify)

Workshop Attendance Please choose the date(s) which you plan to attend the workshop   Thursday, February 26 Friday, February 27 Reception Attendance We are planning to have a reception on Thursday, February 26.
Please let us know if you intend to attend the reception:
Yes No x If you chose yes to the question above,
please check all the slots that you intend to attend:
5:00 - 6:00 P.M., Thursday, February 26
6:00 - 7:00 P.M., Thursday, February 26 Dietary Restrictions Please describe dietary restrictions, if any, that require accomodation.   Comments Please let us know if you have any comments
(e.g. if you have any question for the panelists in one of three planned panels) X