Preferred mailing address:
Home Telephone (optional):
Participant Category (Check all that apply):
Ethnicity (Optional, but helpful in assessing efforts to attract a diverse group of participants and used for grants reporting purposes):
Education: (Include all undergraduate and graduate schools you have attended and any special programs you have attended.)
Will you be able to attend the entire Women's Program from May 12 to May 23?
Have you taken a course in women's studies or women in science? Yes No
What do you hope to gain from the Women's Program?