Tenth Annual CCSM Workshop Registration

Title (i.e., Dr., Mr., Ms.):

*First name:

Middle initial:

*Last name:

*Name on your nametag (the name you go by, first and last):

*Position (e.g., professor, scientist, graduate student, postdoc):

*Organization:

Department:

*First line of address (do not include Org. or Dept.):

Second line of address (do not include Org. or Dept.):

Third line of address (do not include Org. or Dept.):

*City:

State:

*Zip/Postal Code:

*Country:

*e-mail address:

Personal web-page:

*Phone number (###-###-####):

Fax number (###-###-####):

*Primary Working Group (the group to which your research is mosted related)

*Working Groups you are interested in; pick as many groups as apply. Some platforms may require using the control key to pick multiple groups.

Any notes you want to add:

Request for Travel Funds: Deadline to request travel funds is Friday, 4 April 2003.

Disclaimer: Travel funds are limited! There is no guarantee of assistance.

If you are requesting travel funds, please give very specific details of your current CCSM research or your specific future plans for involvement. Your response will help to determine funding. "Specific details" and "type of assistance" are the only required fields, if you are requesting funding.

*Do you need travel assistance?:

* Specific details of your current CCSM research or your specific future plans for involvement:

*Type of assistance needed? (e.g., lodging, per diem, shuttle, airfare). Please note that the standard package that is funded is hotel, per diem, and shuttle expenses.

For help with this form: 'paulad@ucar.edu'
For more information see 'http://www.cesm.ucar.edu/news/logist.html'

Title (i.e., Dr., Mr., Ms.):
*First name:
Middle initial:
*Last name:
*Name on your nametag (the name you go by, first and last):
*Position (e.g., professor, scientist, graduate student, postdoc):

*Organization:
Department:
*First line of address (do not include Org. or Dept.):
Second line of address (do not include Org. or Dept.):
Third line of address (do not include Org. or Dept.):
*City:
State:
*Zip/Postal Code:
*Country:

*e-mail address:
Personal web-page:
*Phone number (###-###-####):
Fax number (###-###-####):
*Primary Working Group (the group to which your research is mosted related)
*Working Groups you are interested in; pick as many groups as apply. Some platforms may require using the control key to pick multiple groups.
Any notes you want to add:

*Do you need travel assistance?:
* Specific details of your current CCSM research or your specific future plans for involvement:
*Type of assistance needed? (e.g., lodging, per diem, shuttle, airfare). Please note that the standard package that is funded is hotel, per diem, and shuttle expenses.

Tenth Annual CCSM Workshop Registration

Request for Travel Funds: Deadline to request travel funds is Monday, 11 April 2005.

Request for Travel Funds: Deadline to request travel funds is Friday, 4 April 2003.