Name:         Campus:

E-mail Address:

Workshop Title:

CIP Goal #:   Obj #: Activity #:

Workshop #:

Workshop Location:

Is this a "Net 3" workshop:  No Yes

If yes, please indicate which Net 3 site:    Rice Admin ELPS

Date (s) of Workshop:

Workshop Fee:

PO #: (please forward PO to Linda Hagen at the Administration Office)

Charge to Account Code (if fee involved):

Please send a copy of this registration (print next page), any other supporting paperwork, Purchase Order and/or any request for travel to your Campus Administrator.

Only the Campus Administrator will send approved paperwork to Linda Hagen at the Admin Office.

**If approved you will be notified via e-mail.**