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PROGRAM REQUEST FORM

Items marked with an asterisk(*) are required fields. Please contact our Conference Office at conferences@mbl.edu, 508-289-7668 if you have any questions or problems with the form.

Program Background Information

If you are human, leave this field blank.

Event Name *

Host Organization Name *

If MBL, Department Name

Contact Name *

Contact Phone Number *

Email *

Desired Program Start Date
Format must be 00/00/0000 *

Desired Program End Date
Format must be 00/00/0000 *

Brief Background of the Event: *

Scientific Purpose/Program of the Event: *

Housing Needs:

Arrival Date
Format must be 00/00/0000 *

Departure Date
Format must be 00/00/0000 *

Allow Early arrivals: *

Yes

No

Total Participation: *

MBL Attendees anticipated: *

Non MBL Attendees anticipated: *

Number of Single Rooms Requested: *

Number of Double (shared) Rooms Requested: *

Event Needs:

Auditorium

Yes

No

Meeting Room

Yes

No

Breakout Room

Yes

No

Poster Session

Yes

No

Abstract

Yes

No

Mixer (with alcohol)

Yes

No

Other

Yes

No

Other add on items at an additional cost that you might be interested in:

Coffee Break- Standard (with snack)

Yes

No

Coffee Break – Basic (no snack)

Yes

No

Lobster Boil

Yes

No

Box lunch

Yes

No

Appetizers at poster sessions/mixers

Yes

No

Plated dinner

Yes

No

Gemma trip

Yes

No

Other notes or helpful information:

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