Science to Society 2010 Application Form

Please complete the following application form and submit by clicking the button at the bottom. We will not accept applications sent by email.

Name
Mailing Address
Phone Number
Email
Your institution
Your degree program
Your supervisor's name
Your area of research interest
Your most recent (e.g. grad school) GPA [no transcript required]

Gender:
Male Female

The class applied for
Basic Class Advanced class

Have you contacted your supervisor and advised them of your application and confirmed they have agreed to you attending if accepted: Yes No

In 100 words or less, please explain why you would like to attend the Science to Society workshop October 22, 2010:

I understand, that if accepted, I am responsible for my travel and costs of such travel to the Banff Centre, in Banff, Alberta, to arrive by 6:00 pm on October 22, 2010. Yes No

I also understand that if accepted I will stay for the duration of the workshop, which will end at 2:00 pm on October 24, 2010. Yes No

I give my permission to share my email contact information with the other participants of this course. Yes No