Registration Form: “WRITE WINNING GRANT PROPOSALS” Presented by, John D. Robertson, Ph.D., Grant Writers’ Seminars and Workshops, LLC Attendance on October 5 is not required. Please indicate which date(s) you will attend, to ensure your materials are ready. October 4, 2016 • 8:30 am – 4:30 pm • POB 2.302 http://maps.utexas.edu/buildings/UTM/POB October 5, 2016 • 8:30 am – 12:30 pm • POB 2.302 http://maps.utexas.edu/buildings/UTM/POB  Registration fee provides the participant with an extensive handout and ONE Workbook, which is required for the seminar.  Registration fee is equal to the value of the workbook selected.  Please complete one registration form for each person attending the seminar.  Seminar is open to The University of Texas at Austin community

A. Participant Information Name Title EID e-mail Phone Department Mailing address Date (s) of Attendance

B. Workbook Selection – for description of each, visit http://www.grantcentral.com/workbooks.html Please mark only one. Selection cannot be changed once ordered. Successful Proposals to Any Agency - $85.00 The NIH Edition - $85.00 The NSF Edition - $75.00 USDA/NIFA - $75.00

C. Payment Method 1. Check or Money Order Please Make your check payable to “The University of Texas at Austin” and be sure to write “GWSW Seminar” in memo line. Mail payment and registration form to: Campus Mail USPS ATTN: Elena V. Mota ATTN: Elena V. Mota Office of Sponsored Projects Office of Sponsored Projects A9000 101 East 27th Street, NOA 5.300, Stop A9000 NOA 5.300 Austin, Texas 78712-1532 2. Visa or MasterCard Call Elena V. Mota directly at (512)232-1419 to process your payment with Visa or MasterCard. Please have your card with you when you place the call. 3. Interdepartmental Billing Department to be charged Account Number to be charged Authorized Signature

Contact Elena V. Mota, (512)232-1419 or [email protected], if you have any questions.