Symposium Registration

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Reitz Union
March 22th, 2017
8:30am - 4:00pm

Name *

Email *

Department *

Classification *

Undergraduate Student

Graduate Student

Post Doc

Faculty

Which of the following best represents you? *

Please see the NIH Diversity Definitions for further clarification (http://www.ninds.nih.gov/diversity_programs/definitions.htm) If you feel these categories do not accurately represent you, please specify in other.

Caucasian

Hispanic, Latino, or Spanish origin

Black or African American

Asian

American Indian or Alaska Native

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

Other:

Required

What is your preferred session? *

Social Sciences/Humanities

Biological Sciences

Math/Physical Sciences

Engineering/Technology

Dietary restrictions *

None

Vegetarian

Other:

Would you like to judge this event? (Faculty and staff only)

Yes

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