Intro to PBL Workshop: Registration Form

An Introduction to PBL

Workshop Date: January 4-6, 2012

Name _________________________________________________________________

Department ____________________________________________________________

Institution ______________________________________________________________

Institution address ________________________________________________________
________________________________________________________

Email _____________________  Telephone ______________________

The following information will help us in planning workshop activities.

Disciplinary Areas: _________________________________________________________________

Do you have any prior experience with PBL?  _______  If so, please comment: _________

FEES:  The registration fee for the conference is $250 which includes workshop materials and refreshment breaks. Participants assume responsibility for living accommodation, meals, and transportation. Please make checks payable to the University of Delaware. 

Please return this form with payment to:

ITUE January Intro to PBL 2012 c/o Susan Groh
Department of Chemistry and Biochemistry
University of Delaware Newark, DE 19716. 

To register your intention to participate while payment is being processed, you may fax this form to (302) 831-6335 or e-mail the information to ud-itue@udel.edu. Please note that PBL@UD cannot accept credit card payments.

Information on travel, accommodations, and restaurants is also available.

Note: There is no registration fee required for participants from the University of Delaware.

Deadline for registration is December 15, 2011.