Voices for Science 2022 Launch Workshop Form: In person attendees Name* First Last Please share your preferred pronouns.* He/him She/her They/them Other Prefer not to say If you answered "other", please share your pronouns here (optional).Email*Please list any dietary restrictions or food allergies.Travel Acknowledgement:* By clicking this box, I acknowledge that I am responsible for contacting AGU travel agents at Global Travel Associates to handle my travel arrangements so my ticket will be billed directly to AGU. Our travel agent is Kimberly Grasso and can be reached via email at [email protected] or by phone at 703-665-4963. I understand that programming begins at 5pm on Wednesday, 6 April and ends at 4pm on Friday, 8 April. Include a short biography of 100 words or less here.*Your biography will be included on AGU's website.Upload a headshot of yourself.*Accepted file types: jpg, png, Max. file size: 60 MB.Your photo will be included on AGU's website.Please share the full name of your department head (or equivalent).* First Last Please share the email address of your department head (or equivalent).*Note that we are asking for information regarding your department head (or equivalent) because we will be sending them a letter commending you for being part of this important program.Photo Release* By checking this box, I agree to the below.During the events of the 2022 Voices for Science Launch Workshop, which will take place in Washington, DC on 6-8 April, the AGU may take photos and/or video for use in future: pamphlets, brochures, and informational booklets; at meetings, lectures, and workshops; in public presentations during meetings and other events; in promotional and educational videos; and on Web sites maintained by the AGU. I give the AGU permission to publish in print, electronic, or video format the likeness or image of myself. I release all claims against the AGU with respect to copyright ownership and publication including any claim for compensation related to use of the materials.CommentsThis field is for validation purposes and should be left unchanged.
