Clone of AMCOP 76 Registration Form

Full Name

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Address

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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

Registration options. Registration includes breakfasts on Friday and Saturday morning and lunch on Friday.

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.

On campus lodging options. Rooms are available as single occupancy ($29.35/night) or double occupancy ($23.50/night/person). The dorms have semi-private restrooms; this means they have a door that locks and are used by one person at a time but are accessed from the hallway. The dorms will be available Wednesday (6/24) for anyone attending the workshop.

There is a $10 fee for linens (pillow, sheets, blanket and towel).

List suite mates below, under options.

Other

If single night was selected, please indicate which night:

The Friday Night Banquet will feature two entrees: either marinated chicken or vegetarian lasagna.

Include a T-shirt with the AMCOP logo above (sizes = S-XXL). Some t-shirts will be available on site but if you want more than 2, please contact Robert for ordering instructions.

Other

AMCOP Annual Dues options

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