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2012 SOR Retreat Application Form

SOR 2012 Research Retreat
August 5 - 9, 2012

in the hills of Upstate NY at Beaver Hollow Conference Center in Java Center, NY (near Buffalo)

Applicants are requested to submit an NIH Biosketch (4 page abbreviated CV).
  • Please email vitae to: retreat2012@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 retreat2012@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 retreat2012@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 an SOR Member
  No, I am not an SOR Member
Full-Time Graduate Student Yes, I am currently a full-time graduate student
  No, I am not currently a full-time graduate student
Student rate Yes, I am requesting the graduate student/post-doctoral fellow registration rate.
  No, I am not requesting the graduate student/post-doctoral fellow registration rate.
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. A very limited number of single rooms are an additional $250 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 $250
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:
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