2018 U-M Neurosurgery Centennial Celebration Registration | September 13-15
Join us as we celebrate 100 years of neurosurgery at the University of Michigan!

• Centennial Conference: $350 per attendee
• Football Tickets: $55 per ticket (You will indicate how many tickets, if any, you’d like to purchase through the department at the end of this registration form. Tickets will be distributed at the event.)
• All Other Centennial Events: No charge

After submitting this registration form, you will be invoiced for your total amount owed within one month. The invoice will be sent to the email address you provide in this form. Payment can be made by check.
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Preferred Name for Your Badge *
Credentials (M.D., Ph.D., etc.) *
Home Address *
Phone Number
What is your preferred method of communication to receive news and updates about this event? *
Dietary – Please indicate any dietary restrictions or allergies you have. We will do our best to accommodate your requests.
Other Needs – Please indicate any special mobility, hearing, vision, etc. needs that you would like to make us aware of.
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms