The magic of theater! The power of inquiry! The excitement of participation!

Application/Interest form for Fusion Science Theater

Name

Email Address

Phone

Institutional Affiliation

Role in Institution

Brief description of outreach group or colleagues

What are your outreach goals?

Please list your outreach activities from the past 2 years and summarize their impact.

How do you see Fusion Science Theater serving your goals?

Could you attend a workshop in San Francisco in March 2010 (in conjunction with the American Chemical Society National meeting, March 21-25th)?

• Yes
• No

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