School of Rock 2014 (IUP)

Page One

1. Please complete the following.

LAST Name *This question is required.

First Name *This question is required.

Title

School/Institution *This question is required.

Mobile Phone Number *This question is required.

Preferred Email Address *This question is required.

Preferred Mailing Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Postal Code *This question is required.

Country

Preferred Phone Number *This question is required.

Website

Is your preferred contact information for your work or home? *This question is required.

May we use the above information in a contact list for participants and instructors?

2. Please provide a brief (5-8 sentences) biography that introduces yourself to other participants and instructors. This will appear on the website. Please send a jpg image of yourself to jcollins@oceanleadership.org

3. Please describe any FOOD restrictions and/or allergies the cook staff should be aware of while you are onboard the JR. *This question is required.

4. Participants will be sharing rooms in the dormitory. Do you have any concerns or factors that we need to be aware of when creating the rooming list? If you are providing your own housing, please write OWN HOUSING below.

5. Would you like to join the JOIDES Resolution list-serve to get updates about expeditions, education activities and more? *This question is required.

Yes, send me news and updates. (We respect your privacy and will not send unsolicited email.)

6. Please provide the names and contact information for PR folks with whom you can work to share your experience.