Name:

Current Street Mailing Address:

City: State:

Country (if different from USA):

Postal Code or Zip Code:

Daytime Phone Number:

Current Email:

Street Address in August 2008, if different from above:

City: State:

Country (if different from USA):

Postal Code or Zip Code:

UVM College:

UVM Department:

UVM Mailing Address:

UVM Email:

UVM Phone Number:

Very important: All sessions are mandatory for faculty represented by United Academics (i.e., all full-time faculty except for those in the College of Medicine). Attending orientation is a contract-stipulated condition of employment.

In order for us to give an accurate count to the caterer, please indicate whether or not you will attend:

Monday, August 25
Breakfast
Lunch

Tuesday, August 26
Breakfast
Lunch

If you need special accommodations, please let us know at least 2 weeks in advance: