SUPERNOVA EARLY ALERT NETWORK WORKSHOP REGISTRATION FORM
========================================================

Name: __________________________________

Email: _________________________________

Affiliation: ___________________________

Arrival date: __________   Departure date: _____________

I am making my own accommodation arrangements: yes/no

If no: please make a reservation for me at: _____________________

      Room type:  Single/Double/Other
   (We will need your credit card information to make reservations.)

      Credit card type:  ___________
      Credit card number:___________
      Expiration date:______________


Please email to schol@budoe.bu.edu