2017 Gorlin Conference Registration
Thank you for your interest in the 2017 Gorlin Conference. Please fill out the following form so we may register you for the conference.

If you are paying by check, please make out a check for $150 to "University of Minnesota" and mail it to:

Hari Prasad
16-116 Moos Tower
515 Delaware St. SE
Minneapolis, MN 55455

If you are paying by credit card, you will be directed to a link to pay after filling out this form. You will need to fill out a form and pay for each individual going to the conference.

Name as it appears on the government issued document you will use for boarding the airplane (First, Middle, Last)
NOTE: Please specify if there is no middle name
Your answer
Email
Your answer
Phone Number
XXX-XXX-XXXX
Your answer
Name you would like to see on your name tag (FIRST, LAST)
Your answer
Gender
Birthdate
MM
/
DD
/
YYYY
How many years have you attended the Gorlin Conference?
1st choice of preferred airport for departure
Your answer
2nd choice for preferred airport for departure
Your answer
Dietary restrictions?
Pay by check or credit card?
Submit
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