Smith Foray Registration Form
Camp Butternut Springs
650 N 175 W
Valpraiso, IN 46385
Attendee Information
Primary Contact
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Affiliation (University, Place of Employment, etc)
Please specify:
*
Professional
Instructor
Graduate Student
Undergraduate Student
Other
Would you be interested in giving a 5 - 10 minute talk? Possible topics could include your current research or research you've completed. (There are limited spots; speaking times will fill up in the order they are received until full.)
Yes
No
Tentative talk title
Choose your registration type:
*
prev
next
( X )
Professional/Instructor/Mycologist
Thursday afternoon arrival/Friday meals/forays/speakers/lodging, Saturday meals/forays/speakers/lodging, Sunday breakfast/casual foray
$
175.00
Student
Thursday afternoon arrival/Friday meals/forays/speakers, Saturday meals/forays/speakers, Sunday breakfast/casual foray
$
125.00
Please select if you have any dietary preferences:
Please Select
None
Vegan
Vegetarian
Gluten-free (non-medical)
Food allergy
Other (Please list under special accommodations)
Which type of lodging would your prefer?
*
Lodge (2 lodges available: Friendship A Lodge sleeps 20, Friendship B Lodge sleeps 24. )
Camping (bring your own tent/camper; limited electrical hook up)
Offsite/Other
For shared lodging purposes, what is your gender identity? (select one):
Man
Woman
Other
Please list any special accommodations needed.
Save
Submit
Should be Empty: