Conference Form
   
PARTICIPANT INFORMATION
* required fields
Today's Date:*

Name:*

Department:*

E-mail Address:*

Extension:*

CONFERENCE INFORMATION

Title:*

Dates:*

Place:*

Website: 

Registration Fee: 

Registration Deadline:*

Conference Hotel:*
Hotel Phone:*

Hotel Conference Code:
Overflow Hotel:
Overflow Hotel Phone:

Please note that UW-P will pay for the room only; no incidentals will be paid.
TRAVEL NEEDS (please check box)
UW-P Fleet Requested Yes No
Driver's Name:
Number of Passengers:
Airline Reservation Requested: Yes No
Departure Date:
Departure Time Requested:
Return Date:
Return Time Requested:
Hotel Reservation Requested: Yes No
Date(s):
UW-System conferences typically book rooms on a double occupancy basis, so if you prefer single occupancy, please note you will be responisble for any additional charges.

Special Accommodations (i.e. Diet, Seating, Room Type, Occupancy, etc.):
FOR PROVOST USE ONLY
Airline:
Date Ticket Booked:
Confirmation #:
Hotel:
Date Reserved:
Confirmation #:
Registration Fee Paid with Card #: