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Second Conference on Laboratory History
April 19-21, 2001
Jefferson Lab, Newport News, VA

Overview | Program | Registration | Travel & Lodging | Instructions for Authors

(Required information is noted in blue.)

Registration Form
First Name
M.
 Last Name
Organization or Affiliation
Mailing Address
Daytime Telephone
Mailing Address
Fax Number
City
 State
 Postal Code
 Country
 Email Address
Name of person to contact in an emergency
Phone
I am a DOE Employee
(Direct government employee, paycheck comes directly from Department of Energy) 		Yes No
I am a DOE-paid Contractor
(Employed by DOE-funded lab or institution such as Jefferson Lab,Fermilab, SLAC, Brookhaven, etc., which operates under contract with the Department of Energy) 		Yes No
 
I have special needs (dietary restrictions, handicapped access, etc.): Yes No
    Vegetarian      Handicapped Access      Other (please specify)     
    Describe:
 
Arrival Date: Departure Date:

Other Events / Companions
Please let us know which events you plan to attend by checking the appropriate box(es) below:

    Wednesday Evening Reception
    Saturday Evening Herman's Harbor House Dinner ($40)
    Sunday No-host Trip to Colonial Williamsburg
I will be bringing a companion:
     Yes No
Companion Name:  

Companion will attend:

    Wednesday Evening Reception
    Saturday Evening Herman's Harbor House Dinner ($40)
    Sunday No-host Trip to Colonial Williamsburg

Housing
Participants are responsible for making their own hotel reservations. A room block has been reserved at the SURA Residence Facility at Jefferson Lab until March 23rd. After that date, rooms will be available on a first come, first served basis. Please call (757) 269-7460 to make hotel reservations. Reservations should be made prior to March 23 to assure availability.
 
Payment Options
The registration fee of $75 includes entrance to all sessions, meeting materials, and conference costs, except the Herman's Harbor House Dinner. By submitting this form you are agreeing to pay the set fee as well as relevant fees as noted above.

Check, payable to SURA/Jefferson Lab
Will pay fee at the conference

Payment may be sent to the following address:

    Second Conference on Lab History
    Attn: Jacqueline Bacon
    Jefferson Lab MS 12C
    12000 Jefferson Avenue
    Newport News, VA USA 23606
    Tel: (757) 269-5117




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