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Please complete the following form for yourself and your guest. All items in bold are required.

Please print the form before you submit it and mail the printed form along with a check for the registration fee and any other fees to:

Laurie Granstrand
CT Space Grant Consortium
University of Hartford College of Engineering
200 Bloomfield Ave
West Hartford, CT 06117

Make checks payable to: University of Hartford (TIN: 06-0731360)

Last Name First Name
Organization Title/Position
Address Line 1  
Address Line 2  
Address Line 3  
City State
Zip Code Phone
Fax Cell
Primary Email Secondary Email
Dietary Restrictions Food Allergies
Check the appropriate boxes for the events you and your guest are planning to attend. If you aren't brining a guest, please leave blank.
Registration fee is $285
 
Self
Guest
Additonal Fees for Guests
Thursday:      
Tour (3-6pm)
Free
Reception (6pm)
Free
Friday:      
Continental Breakfast
$10
Lunch
$20
Tour (3-6pm)
Free
Banquet (6:30pm)
$38
Dinner Options*: (select one)      

Pasta Primavera
(Vegetarian) Fresh vegetable medley with tortellini pasta in a garli-wine butter sauce
Chicken Adams
Boneless breast stuffed with broccoli and cheddar cheese, topped with poulet sauce and served with a baked potato
Baked Stuffed Shrimp
Four jumbo shrimp stuffed with seafood dressing served with a baked potato
Prime Rib of Beef
12oz of beef served with baked potato and a horseradish sauce
Saturday:
 
Continental Breakfast
$10
Lunch
$20
    *A cash bar will be available at dinner
Complete the following only if you are bringing a guest with you to the conference.
Last Name First Name
Dietary Restrictions Food Allergies
Citizenship Status (check one)
 
Self
Guest
  
US Citizen
 
US Green-card (please bring green card)
 
Forgien National
 
       

 

   

 

Copyright © Connecticut Space Grant College Consortium Webmaster Last Updated: August 2008