Registration Form for the Philadelphia LAN 2019
The meeting will take place on Thursday, January 3, 2019 at Geisinger Commonwealth School of Medicine (GCSoM) in Scranton, Pennsylvania. Snow day is Friday, January 4, 2018.

There is no registration fee or charge for on-site parking. On-site registration/check-in will begin at 9:45 am in the Medical Sciences Building Lobby.

Please complete and submit your advance registration no later than December 21, 2018. A follow-up email will be sent to registrants to confirm registration and provide additional information as necessary.

Thank-you,
Mary Engel and Louise Russo
Philadelphia LAN co-coordinators

First name *
Your answer
Last name *
Your answer
Title *
Your answer
Institutional Affiliation *
Your answer
If you are a pre-health advisor, which of the following applies?
If you are a professional school representative, will you be participating in the School Update portion of the afternoon program?
Telephone number (primary work contact) *
Your answer
Telephone number for alerts on the day of the event *
Your answer
E-mail address *
Your answer
Do you have special dietary needs? *
If you have special dietary needs, which of the following apply/applies?
Are you interested in the optional tour of Geisinger Commonwealth School of Medicine after the program? *
Are you interested in connecting with a colleague(s) to car-pool/ride share to the meeting?
If you are interested in connecting with colleagues for car-pool/ride sharing, from what region/area are you traveling? We will collate information and send it to respondents who answered these last two questions to assist in possible car-pool connections in advance of the holiday season.
Your answer
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