Workshop Registration Form
Molecular Visualization in Biological Science Education
Long Island University, Brooklyn NY

For information needed to fill out this form, visit
http://www.umass.edu/microbio/rasmol/workshop.htm
Use your browser's pull-down File, Print menus
to print this form, fill out, then
    FAX to 413-545-2532
or snail mail to:
    Eric Martz
    Department of Microbiology
    University of Massachusetts
    Amherst MA 01003-5720

Location of workshop: LONG ISLAND UNIVERSITY, BROOKLYN NEW YORK

Three meeting dates of workshop (You must come on all three dates!):

Date for first meeting:

Date for second meeting:

Date for third meeting:

Name:

Position:

Department:

Institution:

Email address:

Snail mail address at your college or university:







Voice phone number:

FAX phone number:

Classes you teach (include subject, credit hours, level of students,
and typical enrollment):












Familiarity with the web: expert, moderate, slight, none?

Familiarity with RasMol: expert, moderate, slight, none?

Do you require a wheelchair, or have other special needs?


Confirmation of your registration and further instructions will be sent
to the email address you have given above.