EXPRESSION OF INTENT

Filling in the information below does not commit you to attend, but will help the committee plan for IAVCEI 2017.

Name:

Institution:

Address:

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Email:

No. of Accompanying People:

I intend to submit an abstract: Yes No

I intend to attend a conference field trip:

Pre- conference trip Mid- conference trip Post- conference trip

I am a:

Professional Donor Member Professional Non Donor Member Professional Non Member Student Accompanying Person

(When you hit Submit, the information you input will be added to an email that will open up with your default mail client. Please make sure to hit 'Send' on that email for us to receive it. Thank you! )