Carl R. Woese Institute for Genomic Biology
Where Science Meets Society

SING Participant Information

The Summer internship for Indigenous peoples in Genomics (SING) Workshop will take place this year at the University of Washington from Sunday, July 22nd until Saturday, July 28th. Please fill out the following form to provide information for arranging travel. If you have any questions about travel or accommodations, please email Courtney Fenlon at c fenlon@illinois.edu.

First Name (as listed on driver’s license or passport for airline ticket, if applicable)

Middle Name (as listed on drivers license or passport for airline ticket, if applicable)

Last Name (as listed on drivers license or passport for airline ticket, if applicable)

Telephone Number (mobile number or another number for the airline in case there are any last minute changes)

Date of Birth (this is necessary to order your airline ticket)

Sex (this is necessary to order your airline ticket)

Male

Female

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Are you a US citizen? (this is necessary b/c the University of Illinois uses different forms to reimburse US citizens or non-US)

Yes

Emergency Contact Name

Emergency Contact Number

Departure City

Additional potential departure city (if applicable)

Departure date

Return date back to departure city

Preferred airline (we will attempt to accommodate any airline requests if possible)

Known Traveler Number (if applicable)

Will you need transportation to your local airport?

Yes

Any special instructions?

Will you be using your own vehicle?

Yes

Will you be using a rental vehicle?

Yes

Do you have any food allergies and/or dietary restrictions?

I agree to have my picture/video taken

Yes