I would like to participate in the IBP/UCLA Monitoring avian influenza in landbirds project in 2009.

Program (MAPS/MoSI/MAWS): _____________
Location: __________
Number of stations: ___
Stations: _____________________________________________________________________
Approximate number of captures per year (nearest 100): ____

Contact Details:

Last Name: ________________________________________
First Name: _______________________________________
Organization: _____________________________________
Address 1: ________________________________________
Address 2: ________________________________________
Address 3: ________________________________________
City: _____________________________________________
State/Province: _____________________________________
ZIP/Postal Code: _____________
Country: _____________________________________

Tel. No. (work) ____ ____ ______
Tel. No. (home) ____ ____ ______
Email: _________________________________

Physical Shipping Address (if different from above but can not ship to PO Boxes)

For the attention of: ________________________________________________
Address 1: ________________________________________
Address 2: ________________________________________
Address 3: ________________________________________
City: _____________________________________________
State/Province: _____________________________________
ZIP/Postal Code: _____________
Country: _____________________________________

Station Details
Please list all stations at which you will take samples.  Provide geographic coordinates of banding station and the datum (if known).  In North America the datum will be NAD83 (WGS84) or NAD27 and will be printed somewhere on a paper map (e.g. USGS topographic map) or available from the settings page of GPS unit.  Other regions of the world may use a different datum.

			   Latitude			   Longitude
Station
		DD
	MM	
SS		
DD	
MM	
SS	
DATUM

















































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IBP/UCLA Monitoring Avian Influenza in Landbirds - Registration Form 2009


3/16/2009	The Institute for Bird Populations, Point Reyes Station, CA49456