*Name:

*College where I teach:

*College Address:

*City:

*State:

*Zip code:

Phone number:

*E-mail:

E-mail during the summer (if different):

*Please indicate position type:

Full time

Part-time

Adjunct

Grad Student

Post Doc

*Courses I taught last year (list all):

*Institution(s) where I expect to be teaching next year:

*Estimate of expenses (note: only actual expenses with original receipts will be reimbursed):

Registration:

$425 (through May 15)

$475 (May 16-24)

Lodging (per person, per night):

$149 Fairmont Hotel

$68 On-campus 4-person suite

$95 On-campus 2-person suite

Travel/transportation:

*Please explain how attending the meeting will benefit you, your institution, and your students. Explain a bit about your teaching, the kinds of courses and students you have, what you hope to change or improve. Discuss the underserved populations enrolled at your campus and classes if appropriate. (150 words max.)

*By checking this box, I certify that
1. I belong in one of the three categories eligible for scholarships (see instructions for categories)
2. I will be teaching introductory astronomy next year (if on sabbatical, the next year after that)
3. I tried, but was not able to find travel support through my own institution
4. I am a citizen of the United States.