If you plan on attending, kindly reply with the following information:

First name:  

Last name:  

Email Address:   

Phone:  

Affiliation:  

Date of arrival:  

Date of departure:  

Proposed talk title/subject: 

Do you want to share some memorabilia, photos  Yes  No
or stories about Gerry, told after dinner  Yes  No
or inside the proposed talk  Yes  No

Relationship to Gerry:

 former student, received Ph.D. under Gerry's tutelage

 postdoc under Gerry's supervision

 collaborator

 other, please specify: 


If you have accompanying persons, require any disability-related 
accommodations, have extra dietary needs, etc. please tell us: