SUMMER 2023 PROGRAM Select the workshop you are registering for * - Select -Grant Writing WorkshopEvolutionary Biology Graduate Student Workshop First Name * Last Name * Your Home Institution Address * City * State or Province, and country if not USA * Zip or Postal Code * Phone * Email * Age when you arrive at MLBS * 17 or younger 18 - 20 years old 21 or older Gender (used for shared housing assignment) * Woman Man Other / Preferred Pronouns ... Gender (used for shared housing assignment) Other / Preferred Pronouns ... 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 requestWorkshop participants will be assigned shared housing unless other arrangements are made in advance. These requests are not guaranteed and are subject to available space and additional fees. If you require private housing, please confirm availability prior to arrival. 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 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." Use "Workshop Payment Selection Page" button to choose payment option and continue to the EPay page.You must pay, at minimum, the workshop deposit to complete your registration. A confirmation will be sent when payment is received. If the workshop is full, you will be notified and automatically added to the waitlist. For questions about workshops or your registration please call 434-982-5486 or email enagy@virginia.edu. Mountain Lake Biological Station values diversity and is committed to equal opportunity and affirmative action in all its programs. Thank you very much! CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 13 + 6 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
