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Attendee Registration Form
Registration is required to attend the symposium. There is no fee for UMN guests, but a $100 fee will apply to industry partners and medical liaisons. If you have any questions or need to change your registration, please contact Elizabeth Fedie at
efedie@umn.edu
, or 612-624-0653.
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* Indicates required question
Email
*
Your email
I am registering as a:
*
University of Minnesota member
Sponsor/Booth Representative
Industry Partner/Medical Liason
Other:
First Name
*
(As you want it to appear on your nametag)
Your answer
Last Name
*
(As you want it to appear on your nametag)
Your answer
Degree(s)
*
PhD
MD
DVM
PharmD
MS
BS
Other:
Required
Job Title
*
Faculty
Postdoctoral Fellow
Medical Fellow
Graduate Student
Undergraduate Student
Research/Clinical Staff
Other:
Affiliation
*
(Faculty: Your department. Fellows, students and staff: Your PI lab name. Industry Partners/Medical liaisons: Your company name.)
Your answer
Meal Attendance
*
Light Breakfast at 8am
Lunch from 11:30am-1pm
Reception at 4:30pm
Required
Do you have any dietary restrictions?
Every effort will be made to have suitable dietary options available, however refrigerators (no microwaves) will be available if you wish to bring your own lunch.
Vegetarian
Vegan
Gluten-free
No beef
No pork
Other:
If disability accommodations are needed to participate fully in this event please check here. You will be contacted by our staff to discuss specific needs.
Yes, please contact me about accommodation options
A copy of your responses will be emailed to the address you provided.
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