Application Form for January '98 Workshop

Please complete this form and then press the submit button to register for the meeting. Fill out a separate form for each participant. If you have any questions, please contact Linda Halet at (612)626-1890 or email halet@geom.umn.edu

Applications must be received by January 9, 1998.

Preferred Title:   
 Professor    Dr.    Mr.    Mrs.    Miss    Ms.

Name:            
Department:      
Institution:     
Mailing Address: 
                 
                 

E-mail:          
Phone:             Fax:  

Soc. Sec. Num.:   (needed for reimbursement)

There will be a reception and dinner at the Radisson Hotel Metrodome beginning at 6:30 pm on January 19, 1998. Please make reservations for dinner and/or lodging that night.

I request dinner reservations at the Radison for Monday night.
I request lodging at the Radison for Monday night.

Up: MnSCU/UofM Distance Learning Initiative