Clone of AMCOP 76 Registration Form

Full Name*

First NameLast Name

Institution*

E-mail*

Phone Number*

Area CodePhone Number

Mobile Number

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Please make the following selections for your AMCOP 77 charges using the check boxes and text boxes below.

If you have any questions, please email the Secretary/Treasurer, Robert Jadin, at jadinr@lawrence.edu

Faculty or Professional ($65.00)Student -Undergraduate, Graduate, Postdoctoral ($45.00)Guest ($45)

I would like to participate in the optional workshop #1 “How to prepare specimens for museum deposition and preparation of small mammal study skins” presented by Dr. Agustin Jimenez and Dr. Kurt Galbreath from 9 AM-12PM on Thursday, June 25. Workshop #2 is a wet lab isolating filarial worms and malaria from mosquitoes led by Dr. Shelly Michalski from 2-5PM on Thursday, June 25. These workshops are intended for students and faculty. These workshops are free and open to attendees, please indicate attendance so the appropriate number of materials and stations can be prepared.

Yes, I would like to attend ($0)No, I do not plan on attending the workshop

Double occupancy, three nights ($70.50 total)Double occupancy, two nights ($47 total)Double occupancy, one night ($23.50 total)Single occupancy, three nights ($88.05 total)Single occupancy, two nights ($58.70 total)Single occupancy, one night ($29.35 total)I will arrange my own housing ($0)

Yes please ($10)No thank you, I am bringing my own sheet set. ($0)

Click and list belowOther

Thursday, June 25, 2026Friday, June 26, 2026

I will attend the Friday banquet, marinated chicken. ($35)I will attend the Friday banquet, vegetarian option. ($35)Add a guest, banquet but not attending conference, marinated chicken ($35)Add a guest, vegetarian option ($35)I do not plan on attending the banquet ($0)

Yes, if so please include your size below under other ($20)Add another T-shirt, include second size below under other as well ($20)Other

Faculty or Professional ($20)Student ($10)Guest-dues unnecessary (no charge)

CONTRIBUTION to student awards

Enter an amount you wish to donate to support the student awards. The membership of MAP supports the Herrick LaRue, and Cable awards, as well as all Honorable Mention Awards and student research grants.

Total Due

Please submit this amount through the Givebutter website.

Use the "Submit" button, below, to send your registration preferences to the Secretary/Treasurer.

After submitting this form, please remit payment to our GiveButter site. If you prefer to pay by check, please e-mail Robert (jadinr@lawrence.edu) in advance and then print this form and mail to:

Dr. Robert C. Jadin

1225 Tower Rd.

Rudolph, WI 54475

Make checks payable to Midwestern Association of Parasitologist.

Email

example@example.com