Housing and meals must be arranged at least 3 business days prior to your intended arrival. We cannot accommodate shorter notice. If you are hoping to come within 4 business days, please fill out this form and also email jjones@virginia.edu. Cancelations/changes: In order to prevent billing or be eligible for a refund, you must notify us of any changes to your reservation before 10:30 AM a day in advance of when the change would take effect. Submit a separate housing request for anyone who requires separate accommodations. Personal Information First Name: * Last Name: * Your Home Institution Age when you arrive at MLBS * 17 or younger 18 - 20 years old 21 or older Gender (for housing assignment purposes) * Woman Man Other / Pronouns Gender (for housing assignment purposes) Other / Pronouns What best describes your current status? * Faculty Postdoc Graduate student Undergraduate student Researcher (but none of above) Professional staff K-12 Educator K-12 Student Artist Guest or family member of a resident Other... What best describes your current status? Other... Contact Information Address Line 1 * Address Line 2 City * State/Province, and country if not U.S.A. * Zip or Postal Code * Cellphone number AND provider * This information can help us locate you in case of emergency. Email * Emergency Contact (who will NOT be at MLBS) Name * Relationship Emergency Contact Phone * Visit Details If you're part of a lab, who is the leader? Me Someone else... If you're part of a lab, who is the leader? Someone else... Purpose of Visit * Dates Arrival Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202520262027202820292030 Check in time is 4:00pm. Visits must be arranged three days in advance. If you are requesting within four days of today, complete this form AND email jjones@virginia.edu. Departure Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202520262027202820292030 Check out time is 12:00pm. Number of adults (incl. you) requesting housing through this form * Number of children (12&under at time of visit) List names and genders (for housing assignment purposes) of everyone requesting housing. Provide ages of any minors (12 or under) at time of visit. Group Information Housing requestCourse students, undergraduate researchers, and undergraduate artists will be assigned shared housing. Many other accommodations at MLBS are shared, especially during seasons of high use. If you require private housing, please confirm availability prior to arrival. These requests are not guaranteed and are subject to available space. Dorm/Shared Suite (shared bedroom and bathroom) Single (private bedroom, shared bathroom) Private Suite/Single (private bedroom and bathroom) Private Cottage No Preference Other... Request Other... Dietary Restrictions Indicate any food allergies, and if you have one of the following six dietary restrictions: Vegetarian Pescatarian No red meat or pork Vegan Lactose intolerant Gluten free Meals are served cafeteria style. Quantities of menu items are based on the information folks provide here. Please be mindful of the restrictions you indicated here when you choose items from the serving line to ensure there is plenty for those with dietary restrictions. Dietary Issue Health & Comfort Indicate any medical or personal needs that we should know and/or that might 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 Other Notes - Any other information that might be helpful to know as we make arrangements for you? - If this form includes 2+ people who will cohabitate but need to be billed separately, please indicate that here and provide each person's email. Notes Please review and submit your Housing Request. By clicking submit, you agree to receive occasional emails from us. You may unsubscribe at any time. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 1 + 3 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
