Helen Diller Institute Email List Sign Up Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Today's Date *

YYYY

First Name *

Last Name *

Email *

Affiliation *

Student

Faculty

Staff

Visiting Faculty or Scholar

Community Member

I would like to be added to the following lists (please select all that apply). *

Campus Programs List: you will receive information about programs intended for the campus community (colloquia, workshops, etc). For students, faculty, and staff only.

Student Events List: you will receive information about programs intended primarily for the Berkeley student (undergraduate and graduate) population. For students, faculty, and staff only.

Public Events List: you will receive information about programs intended for the wider public and campus community.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of UC Berkeley.

Does this form look suspicious? Report

Forms