(Note: as prime contact for a Science Alliance event, we need to know how to reach you. This portion of the event submission process records your personal information.)

It's great that you want to be part of the Science Alliance Team by submitting an event! Please use this simple form to sign up as a team member and give yourself a password. You might want to write the password down where you can find it. When you are finished, we'll send you on to the event submission form itself.

Your First Name:

Your Last Name:

Your Middle Name or initial (optional):

Your Title:

Your E-mail address:

Your website URL: (Give full "http://www" address, please, but be careful not to put a period at the end)

Your center, department or other group:

Your room number and building:

Your street address:

Your phone number:

Please choose a username:

Please choose a password:

For more information, contact Tom Zinnen at 608/265-2420 or zinnen@biotech.wisc.edu; or Ken Smith at 608/262-8637 or kennethsmith@wisc.edu; or see http://www.science.wisc.edu

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