--Application Form--Richter Conference

July 8 - 12, 1996

Application Form for Online Conference Participation

The deadline for applications is July 5, 1996. Please supply all requested information and press the submit button at the bottom of the form when you are finished. If you have any questions, or wish to submit an application by mail, send a message to lmix@welchgate.welch.jhu.edu.

Last Name: First Name, Initial:
Position Title:
Organization:
Street Address:
City, State, and Zip Code:
Work Phone: Evening Phone:
Fax:
Email address:

Education and Experience

Summarize briefly your education and professional experience. Include academic degrees, other significant or relevant training, and positions held during the last five years.

If you wish to participate online, is it likely you will participate in all sessions?

Yes

The deadline for applications is July 5, 1996. Participants will be selected and notified by July 7, 1996. Detailed information will be sent then regarding time of chats, and technical requirements for participating in the online conference.

This program is supported by the Research Fellowship Program for the Study of Modern Archives, funded by the Andrew W. Mellon Foundation, the National Endowment for the Humanities, and the University of Michigan; The Alan M. Chesney Medical Archives, The Johns Hopkins Medical Institutions; The Department of Psychiatry, The Johns Hopkins University School of Medicine.