Registration Form for the Philadelphia LAN 2020
The meeting will take place on Friday, January 3, 2020 at Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.

There is no registration fee. On-site registration/check-in will begin at 9:30 am in the lobby of the Medical Education and Research Building.

Please complete and submit your advance registration no later than December 23, 2019. 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, 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
Transportation: Do you intend to drive a car to the event (and therefore make use of the onsite parking option)? *
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 the Lewis Katz School of Medicine after the program? *
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