Symposium to Honor Charles L. Wilkins

Personal Information

First name: Middle initial: Last name:

Phone number:

E-mail address: Confirm e-mail address:

Position: faculty technical staff support staff research supervisor manager sales other If other, please specify

Type of Employer: university/college industry government student/postdoc retired other If other, please specify

Title:

Institution or organization name:

Street address and mail stop:

City:
State:
Zip code:
Country:

All interested parties are welcome to participate in the symposium. However, if you have a special connection to Charles L. Wilkins, please let us know:

former or current student former or current postdoc faculty colleague - U of A faculty colleague - Nebraska faculty colleague - UC Riverside fellow student collaborator other If other, please specify

Lodging

Lodging accommodations for symposium attendees are available at a discounted rate at the Cosmopolitan Hotel in downtown Fayetteville, 70 N. East Avenue. To receive the discount, you will need to phone the hotel (479.772.5555) before August 12, 2008 and mention "Wilkins Symposium" when making reservations. The discount cannot be accessed through the hotel's internet reservation system. Information about the Cosmopolitan Hotel can be viewed at http://www.cosmofayetteville.com/

See http://www.experiencefayetteville.com/ for additional lodging options and Fayetteville information.

Please let us know where you will be accommodated, if known:

Registration

Select the following events you plan to attend. There are no registration fees. The breakfast and banquet are complimentary.

Breakfast buffet - Chemistry Building yes no

Symposium - Chemistry Building yes no

Reception and banquet - Ella's Restaurant at the Inn at Carnall Hall yes no

Will you be bringing a spouse or guest to the banquet who is not attending the conference? yes no

Guest first name: Guest last name:

If you are traveling with family and will need childcare, list your needs, and names and ages of all children.

Please note any dietary restrictions:

Symposium Donations

Notes

Please make note of any special accommodations or suggestions.

Press the submit button to register