Reservation Form

Your Name*

First Last

Email Address*

Gender*

Position*

Advisor Name*

First Last

Affiliation*

UW-Madison Other - Dept Info*

Arrival Date*

Departure Date*

Do you need Housing?*

Yes
No

Hiring Assistant(s)*

If you answer yes, follow prompts below for #, name, email, gender, date(s).

Yes
No

Hiring Assistants - you have hired or will be hiring*

Known
Unknown (hires not complete yet)

Unknown Hiring Assistant(s) - hires not complete yet*

Enter number hiring.

Known Assistants (for name, email, gender & dates)*

Assistant 1

Assistant 1 Name*

First Last

Assistant 1 Email*

Assistant 1 Gender*

Assistant 1 Arrival Date

If different from date you listed being on station

Assistant 1 Departure Date

If different from date you listed being on station

Assistant 2

Assistant 2 Name*

First Last

Assistant 2 Email*

Assistant 2 Gender*

Assistant 2 Arrival Date

If different from date you listed being on station

Assistant 2 Departure Date

If differerent from date you listed being on station

Assistant 3

Assistant 3 Name*

First Last

Assistant 3 Email*

Assistant 3 Gender*

Assistant 3 Arrival Date

If different from date you listed being on station

Assistant 3 Departure Date

If different from date you listed being on station

Assistant 4

Assistant 4 Name*

First Last

Assistant 4 Email*

Assistant 4 Gender*

Assistant 4 Arrival Date

If different from date you listed being on station

Assistant 4 Departure Date

If different from date you listed being on station

Additional Info

Research Project Information*

Please give a one paragraph summary of your research project to be posted on our website. (Limit to 100 words). Please include links to research webpage if available.

Lab Space Requirements*

Please include any specific needs.

Microscope(s) needed?*

Yes
No

Microscope types*

Dissecting scope with camera
Dissecting scope without camera
Compound scope
Inverted scope

Frequency - Dissecting scope with camera*

How often/long will you need to use the dissecting scope with camera?

Frequency - Dissecting scope without camera*

How often/long will you need to use the dissecting scope without camera?

Frequency - Compound Scope*

How often/long will you need to use the compound scope?

Frequency - Inverted scope*

How often/long will you need to use the inverted scope?

Equipment Type and Frequency (For example drying ovens, balances, gas chromatagraph etc.)*

Please include any specific needs.

Refrigerator and/or freezer needed?*

Refrigerator
Freezer
Neither

Frequency - Refrigerator*

Indicate amount of space and time needed.

Frequency - Freezer*

Indicate amount of space and time needed.

Vehicle(s) needed?*

Yes
No

Frequency - Vehicle(s)*

Please include number of days per week and number of weeks (and funding source, if known).

Boat(s) needed?*

Yes
No

Frequency - Boat(s)*

Please include number of days per week and number of weeks.

Field Equipment*

Please describe plans for deploying field equipment in the field.

Additional Information