8th Annual California ALS Research Summit

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8th Annual California ALS Research Summit - Online Registration Form

First Name *

Last Name *

Institution/Affiliation: *

Name and title as it should appear on badge: *

Email Address: *

Address 1:

Address 2:

City:

State:

Zip Code:

Best phone number to contact you: *

I plan to attend the summit: *

Will you be joining us for dinner on Friday, January 19, 2018? *

This will be held at the Sheraton Palo Alto Hotel following the summit activities

Yes

Not Sure

Required

Do you have an administrative assistant that we can contact if necessary?

Please enter their name, telephone, and email address

Special dietary or accessibility needs:

Method of transportation to the conference: *

Where will you be staying? *

If you are staying at the Sheraton Palo Alto Hotel, please list your arrival and departure dates below:

Are you interested in presenting a scientific poster for consideration in a juried competition?

Yes

Maybe/Need more information

Are you interested in presenting a summary of clinical project(s) during the conference?

Note- if "yes", please note the deadline for Poster Submissions is December 30, 2017. Please submit to Clive.Svendsen@cshs.org and cc his assistant at Arleen.Hernandez@cshs.org with a summary of what you would like to present. As many presentations as possible will be accommodated.

Yes

Maybe/Need more information

In your opinion, what were the 1-2 most significant clinical or basic science publications in ALS/MND over this past year?

Any additional comments or questions for the summit organizers?

Submit

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