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United States Department of Agriculture

Agricultural Research Service

OMB 0518-0032 (09/2012)

2nd Annual BARC-UMD Fall Symposium:
Trends in Agriculture

Thursday, October 18, 2012

Patuxent Wildlife Research Center
12100 Beech Forest Rd. Laurel, MD 20708-4039

Registration Form

Early registration is encouraged as walk ins will not be guaranteed a lunch

Instructions
  • Use your mouse to click on each line
  • Type the requested information
  • Click the "Submit" button when finished
"*" Required Field

Name
*Last:     *First:

Other:

Institution/Affiliation:

Mailing Address
Street:

City:

State:

Zip/Postal Code:

Country:

Electronic Contacts
Telephone:

*E-Mail Address:

Posters
Will you be presenting a poster?     Yes     No

Title of Poster:

Abstract Preparation Instructions

Send abstract with subject heading "Fall Symposium 2012" to:     rlawson66@verizon.net

Registration Fee
Registration fees cover conference documents, coffee breaks, and lunches. Please check the appropriate box below then click on the link to the registration fee submission site.

SY/Faculty/SY $25.00    Student or Postdoc $5.00
Retired BARC-UMD Scientists Free

   

Registration Fee Submission Site
http://www.far-b.org/BARC-UMD%252520SYMOPIUM.html

Registration will not be complete without payment.

Registration Confirmation
Confirmation of registration will be sent ONLY by E mail. If you do not include an E mail address, we will not send confirmation of your registration.

More information at Symposium's web site: http://www.ars.usda.gov/ba/fallSymposium2012


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Privacy Act Information: This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974) for individuals completing Federal records and forms that solicit personal information. The authority is Title 5 of the U.S. Code, sections 1302, 3301, 3304, and 7201.
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Effects of Non-Disclosure: Providing this information is voluntary, however, without it we may not be able to respond to you regarding the service you have requested.
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Public Burden Statement: Public reporting burden for this collection of information is estimated to vary from two to four minutes with an average to three minutes per response, including time for reviewing instructions, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Agriculture, Clearance Officer, OIRM, Room 404-W, Washington, D.C. 20250, and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503


Last Modified: 9/25/2012