Computational Modeling Core Workshop Registration Form

Please use the following form to register for the Computational Modeling Workshop to be held on Tuesday, May 7th, 2013.

1. Last Name:

2. First Name:

3. Email Address:

4. Institutional Affiliation (e.g. Univ. of Chicago):

5. Street Address:

6. Country:

7. Phone number:

8. Gender:

9. Citizenship:

Questions 10-11, regarding visa information, are no longer required

12. Select the item which best indicates your current level of education:

13. General area of study (e.g. biophysics):

14. Are you a local resident who will be commuting to the workshop, or a non-local interested in various lodging options?

15. Participants are required to bring a laptop to participate in the workshop, with some setup before arrival. Do you have a laptop you can use during the workshop?

16. Which laptop platform/operating system will you be using?

17. Describe your level of expertise in using VMD:

18. Describe your level of expertise in using NAMD:

19. Describe your level of expertise in using CHARMM-GUI:

20. Supervisor (if applicable):

Please note . . .

Questions 21 and 22 are important for the selection process. Please provide as much detail as possible while staying within a 250 word response limit.

21. Describe in a concise paragraph your background as relevant to the workshop:

22. Provide a concise paragraph about the benefits you hope to accrue from attending the workshop: