Help! Save Stan facilitator Registration

Name

Phone Number

Address

I am Registering as a

Have you participated in the past

Discipline

If other, please specify

Institute Affiliation

If other, please specify

referred by

Workshop - Option 1

Workshop Option 2

Attendance*

I understand that by registering to participate in Help! Save Stan, I have committed to be available from 7:30 a.m. - 4:30 p.m. If there is a need to cancel my participation, I will contact via email by February 22, 2019. I am also aware that my attendance will be shared with my institution.

Workshop*

I understand that in preparation for Help! Save Stan I am required to attend one in-person workshop, as well as complete the on line module.

Photo*

I am aware that video and photos may be taken and used for educational and promotional purposes for Help! Save Stan. I can opt out of being photographed upon check-in at the event

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