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United States Department of Agriculture

Agricultural Research Service

OMB 0518-0032 (12/2015)

3nd Annual BA-UMD Fall Symposium:
Trends in Agriculture

Thursday, January 23, 2014

National Agricultural Library
Abraham Lincoln Building
10301 Baltimore Avenue, Beltsville, MD 20705-2351

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
  • The above action will take you the payment site. Credit cards are accepted and use the drop-down to indicate your status identifying the fee to pay.
  • If you are registering multiple folks or if you are registering someone besides yourself please contact Jim Poulos prior to registering:
    Jim Poulos
    310 504 6464
    Jim.poulos@ars.usda.gov
"*" 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 2013" 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 $5.00

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/fallSymposium2013


Privacy and Paperwork Reduction Act Statements

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.
Purpose and Routine Uses: The information from this form is used solely to respond to you regarding the service you have requested. No other uses will be made of this information.
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.
Paperwork Reduction Act Statement: A Federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number.
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: 11/26/2013
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