Field School in Industrial and Historical Archaeology Michigan Technological University Application Form Name Address City State Zip Daytime Phone ( Evening Phone ( Email You are enrolling for: O Graduate Credit O Undergraduate Credit Describe your Class standing and reason for enrolling in this course: Person(s) to be notified in case of emergency: (include relationship to student) ) ) O Volunteer Insurance provider: Policy #: Phone: Phone: Please identify any food or environmental allergies, physical or health related concerns about which you wish to make us aware: Michigan Technological University’s Industrial Archaeology faculty are committed to equal opportunity in archaeology. Given the nature of fieldwork, students with disabilities or special needs should contact the instructor to discuss accommodations as part of the registration process. The field school is filled on a first come, first serve basis. To ensure a spot on the research team, please complete this form and return it before March 1 to: IA Field School Prof. LouAnn Wurst, Department of Social Sciences, 209 Academic Office bldg. Michigan Technological University Houghton, MI 49931 Telephone (906) 487-3188 Email: l a w u r s t @ M T U . e d u You may send this information by email, instead of hard copy.