Select the conference you are registering for * SEPEEG 2023 First Name * Last Name * Your Home Institution Address * City * State or Province, and country if not USA * Zip or Postal Code * Phone * Email * Age * 17 or younger 18 - 20 years old 21 or older Gender Identity * Female Male Other: Please enter your preferred housing assignment - with males, with females, or private housing Gender Identity Other: Please enter your preferred housing assignment - with males, with females, or private housing Emergency Contact (not a person who will be with you at MLBS) Name * Relationship Emergency Contact Phone * What best describes your current status? * Faculty Postdoc Graduate student Undergraduate student Researcher (but none of above) K-12 Educator K-12 Student Professional staff MLBS staff Artist Guest or family member of a resident Other... What best describes your current status? Other... How did you learn about Mountain Lake? Check all that apply Social media Email announcement to me, or forwarded to me Brochure, Poster or Display MLBS web site or direct search Current or former Mountain Lake student Current or former Mountain Lake faculty Instructor, Mentor or Colleague On-line database clearing house Other... How did you learn about Mountain Lake? Check all that apply Other... Have you ever been to Mountain Lake Biological Station before? If so, in what capacity? No Yes Have you ever been to Mountain Lake Biological Station before? If so, in what capacity? Yes Housing requestThe majority of conference participants will be assigned shared housing. You are welcome to request a private space, but these requests are not guaranteed and availability is very limited. If you require private housing, please confirm availability prior to arrival. And you can use this section to request a housing assignment with another conference attendee. I do not need housing. I will be staying off-site Dorm/Shared Suite (shared bedroom and bathroom) Single (private bedroom, shared bathroom) Private Suite/Single (private bedroom and bathroom) Private Cottage No Preference Roommate request? Enter name of another conference attendee. Request Roommate request? Enter name of another conference attendee. Dietary Restrictions Indicate dietary restrictions (vegetarian, vegan, lactose intolerant, no pork, celiac disease) and food allergies. The dining hall can accommodate basic dietary restrictions but cannot cater to other individual food preferences. Dietary Issue Health & Comfort Indicate any medical or personal needs that may require special accommodation (e.g. allergies, disabilities, medication storage). Please also tell us anything we might find useful in providing for your safety, health, and comfort. Alternatively, you may email mlbs@virginia.edu or call 540-626-7196. Concerns Issue Submission Confirmation * CHECK THIS BOX as a digital signature: "I certify my identity is accurate, and that information provided here is complete, accurate, and ready to submit." You must pay the workshop fee to complete your registration. For questions please call 434-982-5486 or email mlbs@virginia.edu. Mountain Lake Biological Station celebrates human diversity in all its forms and is committed to providing respectful treatment and a welcoming environment to everyone. UVA ensures equal opportunity in all its programs. We look forward to having you at the station! CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
