Your Name:
Complete address:
Area Code & Phone Number:
Email:
Fax:

If you will have a co-leader, provide name, etc below:

Title of Proposed Program:

Maximum number of participants:

Book or other material on which the program is based (give full citation):

Do you want this book/source to be available at the SI Bookstore? Yes No

Suggested supplemental books, etc.:

Materials participants should bring:

What are your space needs for this workshop? inside/outside, type of room, etc.

Do you need any audio/visual or other special equipment?

Will you need materials to be copied? If so, estimate amount:

Please provide the following for the brochure: A two or three line bio of the leader(s):

A two or three line description of the course:

The Summer Institute Registrar notifies participants for which morning workshops they have been registered. Some workshop leaders like to communicate more detailed information in advance. If your proposal is accepted, we'd like to know your preference. Please check one of the following:

I will contact participants in advance, so SI should send me a list in June.

I don't need to send additional information; the Registrar's confirmation is sufficient.

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