UIC Neuro Conference Registration

UIC Neuro Conference Registration

Please register for the UIC Neuro conference by filling the form below.
Full Name*

First NameLast Name
E-mail*
example@example.com
Student ID #*
University / Affiliation*

Department / Major

CityState / Province

Postal / Zip Code
Motivation*

* In 2-3 sentences: What made you register for this conference? 0/100
Will you be attending Lunch and Networking. (12 pm -1 pm)
Do you have any dietary restrictions?

YESNO
If you answer YES above, please indicate your dietary restrictions.
This registration is conducted strictly for the UIC Neuro Lunch, and the information you provide will be kept confidential and used only for registration purposes.
Should be Empty: