2017 WiscAMP Student Leadership Symposium & Annual Meeting REGISTRATION
Last name
Your answer
First Name
Your answer
E-mail address
Please provide an e-mail address so we can contact you with information about this event.
Your answer
Phone number
Please provide a phone number so we can contact you with information about this event.
Your answer
Preferred method of contact
Please indicate whether you prefer to be contacted by e-mail or phone
What WiscAMP institution do you attend or work at?
Please select the institution from the list below.
Will you be staying at the Union South Hotel Friday night?
Double room accommodations for Friday night are available for students attendees from outside of Madison. Faculty & staff are provided with single rooms. Travel and food will be reimbursed. Breakfast and lunch are provided on Saturday.
Will you be needing parking on Saturday?
Do you have any food allergies? Please describe your dietary requirement in the space provided.
We will be serving buffet-style meals for breakfast and lunch with vegetarian options.
Your answer
Please provide your gender...
We are using this question to assign students to double occupancy rooms
Please indicate your ethnic/racial background
Check multiple boxes if you need to:
Required
Are you registering as a student or a non-student
Next
Never submit passwords through Google Forms.
This form was created inside of UW-Madison Google Apps. Report Abuse - Terms of Service - Additional Terms