Name:
Street_Address:
City:
State:
Zip_Code:
Centenary CollegeUniversity of Lousiana LafayetteUniversity of Louisiana MonroeNicholls State UniversityNorthwestern State UniversitySoutheastern Louisiana State UniversityLouisiana State University Baton RougeOtherUniversity of Southern MississippiUniversity of Southern AlabamaLUMCONCollege of Charleston, SCTulane UniversityUniversity of West Florida, CEDB Other:

Email:
Phone:
Cell:
REGISTRATION FEE: $15

(Includes a Friday night social and Saturday lunch)
Registration at the door will be $20 and there is no guarantee of a dorm room!

LUNCH Vegetarian option

DORM FEES
Dorm: One Night ($8.00) linens/towels not provided?
Dorm: Two Nights ($15.00) linens/towels not provided?

Preferred Dorm Room:

Two Person Room
Three Person Room
Bunk Room (multiple people)

Preferred Roommates: Roommates(list up to five):

BANQUET FEE: $15 Vegetarian option
I am interested in a Sunday canoe trip.
I will present a poster. Poster_Title:
I will present a presentation. Presentation_Title:

T-SHIRT SIZE: S M L XL XXL

TOTAL$

Please print receipt and mail along with check payable to MER, to:
Marine Environmental Researchers
Care of: Kirsten Simonsen
2197 Energy, Coast & Environment Bldg
Louisiana State University
Baton Rouge, LA 70803