Registration
Please fill out the following information.

Registration fees may paid by check or credit card: see below for details.

Email address *
Name *
Your answer
College/University/Instituion *
Your answer
Major/Department/Program
Your answer
Phone
Your answer
Status (check one) *
If you are faculty, would you be willing to be a judge for presentations?
Are you paying for registration individually or as part of a group? *
If paying with a group, please list the group:
Your answer
Do you prefer a vegetarian lunch? *
Any other dietary restrictions?
Your answer
Registration Fees
By Registration Deadline: September 1, 2017
$25: undergraduate student/graduate student/other
$30: faculty

Late Registration Deadline: September 25, 2017
$30: undergraduate student/graduate student/other
$35: faculty

On-site Registration (September 30, 2017)
$35: undergraduate student/graduate student/other
$40: faculty

You may pay by Check or by Credit Card:

By Credit Card:
We cannot take online credit card payments, but we can process credit cards with a valid credit card number. DO NOT SUBMIT A CREDIT CARD NUMBER ONLINE! THIS IS NOT A SSL (SECURE) site! Payment by credit card can be made with the following methods:
a) You may mail us the credit card number and expiration date on a print-out of your registration confirmation email (see mailing address below).
b) You may pay on-site using a credit card. Registration fees will be determined by the submission date of the completed registration form.
c) Call us and pay over the phone. Please email neuroscience@owu.edu to schedule a time for us to take your information.

By Check:
Make checks payable to: Ohio Wesleyan University.

You will receive an email with your responses confirming your submission. You may include a print-out of this email with your check.

If you are paying for a group, please include a list of the complete names (or email print-outs) of all registrants with your check or credit card number.

Send check or credit card information to:
mGluRs
c/o Chris Fink
Neuroscience Program
Ohio Wesleyan University
61 S. Sandusky St.
Delaware, OH 43015

A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of OWU BishopApps. Report Abuse - Terms of Service