NUCLEI 2013 Registration

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Please fill out the form below to register for NUCLEI 2013 and to let us know if you will be attending the Reception on Sunday, June 23 and/or the Conference Dinner on Wednesday, June 26. This will provide us with an accurate count of numbers attending NUCLEI 2013 for catering purposes. Deadline for registration is June 10, 2013.

Last name *

First name *

Affiliation *

Position

Mailing address *

Email *

Cell phone

Name of accompanying person

Do you want to give a talk?

Title of talk

I will be arriving *

I will be departing *

Name of hotel where are you staying in Bloomington *

Will you have a car that you can share?

Please list any dietary restrictions

Number attending the reception on Sunday, June 23 *

Number attending the Conference Dinner on Wednesday, June 26 *

Preference for Dinner entree *

Guest preference for Dinner entree *

Comments or questions?

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