Home 2009 SOR Retreat

SOR Retreat Application

August 9 - 13, 2009
at the beautiful Asilomar Conference Grounds in Pacific Grove, California

Applicants are requested to submit an abbreviated vitae (4 page maximum).

Please email vitae to: researchretreat@ptresearch.org
Must include in subject line: [your last name]VITAE (e.g. SmithVITAE)

Submission of an abstract is optional. If one is submitted:

Please email abstract to researchretreat@ptresearch.org
Subject line: [your last name]ABSTRACT (e.g. SmithABSTRACT)

All graduate student applicants:

Must have faculty adviser submit verification letter of student status to researchretreat@ptresearch.org.
Email must be from faculty adviser's academic email
Email must include in subject line the word "Verification" (e.g. SmithVERIFICATION)

Your application does not guarantee acceptance.

First name:	^*
Last name:	^*
First name preferred for name tag:	^*
Address:	^*

City:	^*
State/Province:	^* Zip: ^*

Business phone:	^*
Alternate phone:
Cell phone \| Home

FAX number:
Email address:	^*
Educational/Research Institution or Company:	^*

APTA Membership:^*	Yes, my member number is:

	No, I am not an APTA Member

SOR Membership:^*	Yes, I am a SOR Member
	No, I am not a SOR Member

Most attendees will be housed in shared rooms. Please indicate below by providing names(s) of requested roommate(s). Most rooms are doubles; there are some triples and quads. A limited number of single rooms are an additional $200 and will be assigned on a first requested basis.
Room Preference:	I'm happy to share a room (Enter roommate preferences below)
Choice 1 roommate:
Choice 2 roommate:
Choice 3 roommate:
Assign me a roommate:	I am a Female Male^*
	I would prefer a single room and understand it will cost an additional $200

Sending an Abstract:	Yes, I'm sending an abstract (email using format above)
	No, I'll not be sending an abstract

Shared information:	Please include me in the participant roster
	Please do not include me in the participant roster

Special Needs:

Enter code:	* Enter the code in the graphic below to help eliminate spam entries.
	or

^* indicates a required field.

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