RESERVATION DEADLINE: Housing and meals must be arranged no later than 10:30 a.m. a day prior to the arrival date. If you are requesting a visit within two business days from now, please fill out this form, and also call 540-626-7196 and email email@example.com. 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. Other forms: All Station users and guests must complete a liability waiver online prior to arrival. Waivers are valid for 3 years. If you wish to conduct research, lead a group, or host an event at the Station, or if you are requesting financial support for your work from MLBS, you must complete a Station Use and Research Application. NOTE: Please submit a separate housing request for each person requiring separate accommodations. Families or other cohabitating groups can request together. Personal Information First Name: * Middle Name: Last Name: * Age when you arrive at MLBS * 17 or younger 18 - 20 years old 21 or older Sex * Female Male Other / Preferred Pronouns ... Sex Other / Preferred Pronouns ... 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... Contact Information Address Line 1 * Address Line 2 City * State/Province, and country if not U.S.A. * Zip or Postal Code * Phone * Email * Emergency Contact (not a person who will be with you at MLBS) Name * Relationship Emergency Contact Phone * Visit Details If you are coming as part of a lab or group, who is the leader? Me Someone else... If you are coming as part of a lab or group, who is the leader? Someone else... Purpose of Visit / Name of group * Dates Arrival Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201820192020202120222023 Check in time is 4:00pm. For arrivals in less than two business days, complete this form, but also call 540-626-7196 AND email firstname.lastname@example.org. Visits must be arranged NO LATER than 10:30 AM a day prior to your desired arrival. Departure Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201820192020202120222023 Check out time is 12:00pm. Number of adults (including yourself) requesting housing through this submission * Number of children (12 and under at time of visit) List names and genders of everyone requesting housing through this form. Also provide AGES of any minors Group Information Housing requestCourse students and undergraduate researchers are assigned to dormitory-style accommodations. Requests are not guaranteed and are subject to available space. Dorm (shared bath) Suite (private bath) Private Cottage No Preference Other... Request Other... Health & Comfort Indicate any medical or personal needs that may require special accommodation (e.g. disability, medication storage, allergies). Please also tell us anything we might find useful in providing for your safety, health, and comfort. Alternatively, you may email email@example.com or call 540-626-7196. Concerns Issue Dietary Restrictions Please indicate dietary restrictions (vegetarian, vegan, lactose intolerant, no pork) and any food allergies. Dietary Issue Other notes? **If there are multiple people represented on this request and you will need separate bills, describe the breakdown here and provide each person's email address** 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.