Registration

1

Name (First and Last)* This field is required.

2

Current location (City, State)* This field is required.

3

E-mail address* This field is required.

4

Phone number* This field is required.

5

Education* This field is required.Please list highest level of education and related concentration/major

6

Affiliation (school, organization, etc.)* This field is required.

7

Why do you want to participate in this seminar? What do you hope to gain or learn?* This field is required.

8

Please note your dietary preferences or restrictions below.* This field is required.

Omnivore

Vegetarian

Vegan

Gluten Free

Other

9

Do you need financial assistance to attend this seminar?* This field is required.

YESNO

10

Please list your financial needs.If you are traveling from outside the Houston area and have a financial hardship, please use this section to explain your circumstances. Housing will be provided for Friday, Saturday, and Sunday night. Limited funds are available. The organizing committee cannot guarantee full financial assistance but we will do our best to help defer costs. For questions or concerns, please e-mail mbs@viettan.org.