Sample Registration – MERCURY Consortium

Wed, 21 July 2016 15th Annual MERCURY Conference on Computational Chemistry

Please fill the registration form below and click on the “Reservation” button at the bottom.
Confirm your entries in the next screen by clicking on the “Confirm” button at the bottom left.

After submission, you will get a registration confirmation email. Please print a copy of that email and mail it along with your registration fee to the following address by July 8th:

Bucknell University
MERCURY Conference
Office of the Dean of Arts and Sciences
Lewisburg, PA 17837

Starting Event 12:00

Close Reservation 11 July 2016 12:00

Students under the age of 18 have to stay off campus in a hotel and be supervised by their parent(s) or an adult from their institution. Conference accommodations for students above the age of 18 are double-occupancy dorm rooms with shared baths, linens and AC. If students need single occupancy rooms, they need to provide a justification in the registration form.

We are able to provide single-occupancy rooms for faculty and people with special needs if requested. You will need to bring your own toiletries. If you would prefer to stay off-campus, please contact us for recommendations in the area.

Housing is only guaranteed from 12PM on Thursday, July 21st to 2PM on Saturday, July 23rd. Attendees who need to arrive early or stay later because of their travel plans or mini-workshop attendance have to make special arrangements. Please contact us at support@mercuryconsortium.org.

Make a Reservation

Wed, 21 July 2016 15th Annual MERCURY Conference on Computational Chemistry
EMail Address*	Notify me by mail when other new events are posted
First Name*
Last Name*
Name for Badge
Organization/Institution*
Department
Position/Title*

	To comply with Pennsylvania law (Act 153), students under the age of 18 have to stay off campus in a hotel and be supervised by their parent(s) or an adult from their institution. Students are required to provide their date of birth. Others can select “non-student”.
Date of Birth*
Month of Birth*
Year of Birth*
Address*
City*
State*
Zip*
Country*
Phone*
Gender*
	NSF and Research Corporation Sponsored Workshop
	The pre-conference workshop will be held on Thursday, July 21st from 1:30-5:00PM. Once the limit of 24 participants has been reached, you can request to be added to the waiting list by emailing support@mercuryconsortium.org. Workshop attendees need to arrive before 1:30PM on July 21st.
Attending the workshop?*
	ITINERARY
Arrival type*
Arrival date*
Arrival time(Workshop attendees need to arrive before 1:30PM on July 21st)*
Departure date*
Departure time*
	ACCOMMODATIONS
	Faculty and people with special needs will have single occupancy rooms. Students will be housed in double occupancy rooms unless they provide a justification below for needing single rooms.
Housing*
Justification for single rooms (for students)
Student’s roommate preference (if any)
Special Needs
Dietary Restrictions
Meals(check all that apply)	Thursday dinner Friday breakfast Friday lunch Friday dinner Saturday breakfast Saturday lunch
Submitting Abstract/Present Poster*	Yes No
Consortium Member*	Yes No
Registration Fee*
Payment Method*

(Make payable to Bucknell University)
Notes/Comments