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INSTRUCTIONS

Note: Registration is open to FQXi members and by invitation.

Please complete this entire form—including flight information—before submitting it. Fields marked with an asterisk are required and may not be left blank.

You can: (1) complete and submit the form all at once, or (2) complete part of the form, save it, and return to the form later to complete and submit it. You'll use your e-mail address as a unique identifier to allow you to save the partially completed form and retrieve it later.

(1) To submit the form, click the "submit registration to FQXi" button at the bottom to send your registration information to FQXi.

(2) To save a partially completed form, click the "save partially completed form" button at the bottom. If you've saved a partially completed form and wish to retrieve the saved form data, enter your e-mail address immediately below the instructions and click the "retrieve partially completed form" button. Your registration form will not be sent to FQXi until you click the "submit registration to FQXi" button.

E-MAIL ADDRESS
 *


BASIC INFORMATION

Name
 *

Institution
 *

Institution Address
 *

Phone
 *

Please list any food restrictions or allergies:


Do you have any medical conditions that we should be aware of while aboard the cruise?


Emergency contact while in Bergen and Copenhagen:
Name:  *
Phone:  *
Email:  *
Relation to You:  *

If you want to bring a companion, please share their name and note if they are under 18 years of age.


(There is a limit on the number of passengers we can have aboard the cruise. We have a small number of spaces available for companions at a flat rate of US$400 per person. Once these slots have filled up, we will put people on a waitlist and determine if there is space after registration has closed. Please note, indicating that you're bringing a companion doesn't guarantee space on the cruise for this person. You can email rajanna@fqxi.org to check for availability.)

Are you willing to share a room?

If yes, please note if you have a roommate preference. We will only pair people if there is a mutual request, otherwise roommates will be assigned randomly.

TALKS & DISCUSSIONS

If you'd like to give a talk, please include the title of the contribution here:


(Talk assignments and lengths will be made closer to the conference date in the context of the conference program and the total number of speaking slots desired. Most speaking slots will probably be kept quite short so as to maximize time for discussion.)

Please indicate 1-3 foundational questions that
interest you most, either from the list or not.
 *



ATTENDEE SUGGESTION

If we have extra space, whom do you suggest we invite to the conference (someone who is neither a member or currently listed as an attendee) who would bring a lot to and from the meeting?


TRAVEL INFORMATION

The conference begins on Saturday, August 27, 2011 in Bergen, Norway. Please plan to board the National Geographic Explorer cruise ship in Bergen at 12PM. The cruise will disembark in Copenhagen, Denmark on August 29, 2011. The conference will then continue in Copenhagen for an additional three nights and conclude on Thursday, September 1, 2011.

Due to the nature of this conference, we suggest that you book an open-jaw ticket, flying into Bergen, Norway and out of Copenhagen, Denmark. Alternately, you can fly in and out of Copenhagen and get a one-way transfer to Bergen.

FQXi will secure a group rate at a hotel in Bergen for the night of August 26 for any attendees flying in the day before the cruise starts. We will share this info as soon as it becomes available.

Travel to the Conference

Airline and Flight Number
 *

Departing City
 *

Departing Date
 *

Departing Time
 *

Arriving City
 *

Arriving Date
 *

Arriving Time
 *

Travel Home

Airline and Flight Number
 *

Departing City
 *

Departing Date
 *

Departing Time
 *

Arriving City
 *

Arriving Date
 *

Arriving Time
 *


CHARTER CRUISE INFORMATION

Please note that the following information is needed for security reasons by Linblad Expeditions for our cruise aboard the National Geographic Explorer:

Passport Number
 *

Passport Place of Issue
 *

Passport Expiration Date
 *

Citizenship
 *

Date of Birth
 *

Home Address
 *
(include street, city, state, zip)

Special Diet or Medical Information
 *
(if not already stated above)

If you indicated interest above in bringing a companion, please
enter charter cruise information for your companion