[NCSU Statistics]  A Pipeline Issues Workshop
for Faculty of Women's Colleges and
Minority Serving Institutions		 [ASA Home] 

Registration Agenda Organizers Sponsors Contact

Registration

Please complete and submit the following online form. You will receive an email confirmation acknowledging your registration.
There is no registration fee for this workshop.

First Name:
Last Name:
Title
Institution
Department
Address
City
State
Zip
Phone
Fax
Email
Emergency Contact Name
Emergency Contact Phone
Dietary restrictions/
Food allergies

Would you like to be considered for funding to attend this workshop? Yes No
        If yes, what are your estimated travel costs:
Will you drive to the workshop? Yes No
Do you live more than 30 miles from NC State University? Yes No
Do you need lodging nearby in order to attend this workshop? Yes No
If yes, would you prefer a non-smoking room? Yes No
If yes, would you prefer a handicap accessible room ? Yes No

 

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