Henderson DUSEL Capstone Workshop 2006: Online Registration Form



PERSONAL INFORMATION:
 Name as it should appear on name badge:
 (please do not use special accents, i.e. umlauts etc.)
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   Affiliation: 

 Email: 

 Mailing Address:

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 Day Phone:   Fax: 


REGISTRATION FEE FOR PARTICIPANT: Registration Fee: none
LOCAL TRANSPORTATION INFORMATION: If needed, daily transportation to and from the following hotels will be provided: Holiday Inn Express, Danford's on the Sound and Heritage Inn. Daily transportation from hotel to campus needed: Yes No If yes, please provide the name of the Hotel where you will be staying: Parking Permit needed: Yes No
SOCIAL ACTIVITIES WORKSHOP DINNER May 5 Do you plan to attend the workshop dinner on Friday, May 5? Yes No (The workshop dinner cost is waived for the workshop participants only. The cost for accompanying adults is $25 each and $15 each for children.) Additional Dinner Tickets (not including participant): Number of Adults ($25): Number of Children (under 12) ($15): Payment for additional dinner tickets is due at the workshop. Please pay kindly by cash. NY METS VS. ATLANTA BRAVES BASEBALL GAME May 7, 1:10 PM Would you like to attend the Mets - Braves baseball game on Sunday, May 7? Yes No If yes, please indicate the number of tickets: Seat type: Right field 1st base side ($28) This includes ticket price, handling fee.** The Mets are expected to win the division Championship this year over the Braves. BROADWAY SHOW May 7 Would you like to participate in the outing to see the Broadway Show "Mamma Mia" on Sunday, May 7, 7pm in Manhattan? Yes No If yes, please indicate the number of tickets: Seat type: Orchestra or 1st Mezzanine ($70) This includes ticket price and handling fee.** ** For the Mets game and Broadway show, payment is due when you receive tickets at the workshop. Please pay by check or cash (checks should be payable to "Chang Kee Jung"). There are only limited number of tickets available. So, make your reservations as soon as possible. COMPANION PROGRAM May 4 - 6 If you are attending the meeting with a companion, will your companion be interested in a companion program? Yes No (The program can include a tour of Stony Brook/Three Village area, a trip to the east end of Long Island including wineries, and a trip to Manhattan.) If yes, please provide your companion's name:
TOTAL: Please sum all the above amounts: Total Add. Dinner Tickets: $ Total Mets/Mamma Mia Tickets: $