Centennial Registration Form

The UA Physics Department strongly encourages all participants to preregister as soon as possible to help us better plan our Centennial events. Alumni who preregister by February 15, 2008, will be entered into a drawing, from which ten people will win two nights free accommodation at the Clarion Inn.

Personal Information
Name (first and last) Email Address Repeat Email Address

Please check all that apply: Student/Former Student Faculty/Former Faculty Other

I will be accompanied by (list all names)

If you will be accompanied by a former student or faculty member, please ask him or her to register independently, so that the appropriate nametags will be generated.

Students/Former Students: for your nametag, please enter the years for each UA Physics degree received:

BA Year:

BS Year:

MA Year:

MS Year:

PhD Year:

I/We need transportation to/from:
Clarion Inn Cosmopolitan No Transportation Needed

I/We will attend the following events:

Ketterle Lecture	I	My Guest(s)
Friday Morning Session	I	My Guest(s)
Friday Afternoon Events	I	My Guest(s)
Saturday Morning Session	I	My Guest(s)

Check here if interested in alternate activities for your guest(s)

Friday Banquet
A separate invitation to the Friday evening banquet with meal options will be sent by US Mail to all alumni and former faculty. If you did not receive a letter from us this fall, or if your preferred address is different from the one at which you received our letter, please provide your updated address below.

Street City State Zip Code

Anything Else?
Please provide any other information that will help us make your visit to Fayetteville more pleasant:

After you submit this form, you will receive an e-mail confirmation. If you do not, or if you have any other problems, please contact us at centphys@uark.edu.