Registration Form
Please register by Tuesday, January 19 to be considered for hotel accommodations and partial travel support.
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Please fill in all relevant information.
Required fields are marked with
*
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* First Name:
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* Last Name:
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* Affiliation:
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* Status:
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* Year Ph.D. was obtained:
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* Address:
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* City:
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* State:
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* Zip:
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* Phone :
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* Email Address :
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Which nights will you need hotel accommodations?
Thursday
Friday
Saturday
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Are you interested in a contributed talk:
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I will be traveling by car:
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I will be flying into Albuquerque:
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Do you need support:
yes
no
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The following information will be useful for reporting purposes
(no individual data will be reported, only the statistics):
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The following definitions are used by the federal government.
- White: (Not of Hispanic Origin):
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
- African-American: (Black/Not of Hispanic Origin):
A person having origins in any of the Black racial groups of Africa.
- Hispanic:
A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
- Asian or Pacific Islander:
A person having origins in any of the original people of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. The area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa. The Indian Subcontinent takes in the countries of India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan.
- American Indian or Alaskan Native:
A person having origins in any of the original peoples of North American and who maintains cultural identification through tribal affiliation or community recognition.
- Disabled Veteran:
A person entitled to disability compensation under laws administered by the Veterans Administration for disability rated at 30% or more, or a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty.
- Vietnam Era Veteran:
A person who served on duty for a period of more than 180 days, any part of which occurred between
August 5, 1964 and May 7, 1975.
- Individual with Disabilities:
The Rehabilitation Act of 1973, as amended, defines a "handicapped individual" and the American with Disabilities Act defines a "qualified individual with disabilities," for the purpose of the program, as any person who (1) has a physical or mental impairment which substantially limits one or more of such person's major life activities: (2) has a record of such impairments: or (3) is regarded as having such impairment.
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American Indian or Alaskan native
Hispanic
African-American (Non-Hispanic)
White (Non-Hispanic)
Asian or Pacific Islander
U.S. Citizen?
yes
no
Disabled?
yes
no
30% Disabled Veteran?
yes
no
Vietnam Era Veteran?
yes
no
Gender
male
female
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