REQUESTS FOR ASSISTANCE WITH WORKSHOP COSTS
Please complete the form, print out and SUBMIT it by fax or mail to conference
planners to:
Cheryl Anderson, AICP, Planner and Program Manager
UH Social Science Research Institute
2424 Maile Way, Saunders 719
Honolulu, HI 96822
Tel: 808.956.3908
Fax: 808.956-2884 fax
Email: canderso@hawaii.edu
*To be considered for assistance, we must have your completed form in hand by May 1, 2004.
Today's Date: _____________________________________________
First Name: ______________________________________________
Last Name:_______________________________________________
Organizational Affiliation: ____________________________________
Contact Information:________________________________________
Address: _________________________________________________
________________________________________________________
Telephone: _______________________________________________
Fax:_____________________________________________________
E-mail:___________________________________________________
What is your role? __________________________________________
How long have you been with this organization? __________________
Briefly describe other relevant experiences or affiliations. If you are a researcher, what topics have you investigated?
_________________________________________________________
City & Country of Departure: __________________________________
Airline: ___________________________________________________
Estimated airfare for round-trip travel between your major city of departure and Honolulu:
_______________
If you have special needs, please describe them here: ______________
_________________________________________________________What is the minimum level of support needed to enable you to participate?
(check all that apply):
___ International airfare
___ Ground transportation in Hawaii
___ Registration
___ Accommodations (only shared accommodations can be provided)
___ Related expenses, e.g. visa application
___ Other (be specific) _________________________________
Are there any other extenuating circumstances we should know about?
_________________________________________________________
Why do you want to attend the Honolulu workshop?
_________________________________________________________
What specific contribution(s) would you like to make (please check all that apply):
___ Invited speaker (on which panel? see Agenda)
_________________________________________________
What are the main ideas of your ten-minute presentation?
_________________________________________________
___ Workshop facilitator (on which workshop? See Agenda)
_________________________________________________
What background, expertise or skills recommend you for this role?
_________________________________________________
___ Poster session (describe in brief):
_________________________________________________
___ Resource materials (describe in brief):
_________________________________________________
___ Other? (be specific)
_________________________________________________
Thank you for your interest in the workshop! Because funds are very limited, we will not be able to meet everyone's needs but each application received by May 1 will receive close attention.