1st NEUROSCIENCES HUMAN RESEARCH DAY
Advancing Neurosciences: Bridging Minds through Human Research
Conference Online Registration
Please fill in the form below to register for this event. You can email Ileana Rubio at irubio@health.ucsd.edu for questions or additional information.
Full Name
*
First Name
Last Name
I will attend:
Yes
No
Undecided, will confirm later
Other
Role
*
Please Select
Administrative
Faculty
Fellow
Post Doc
Research Coordinator
Research Manager
Other
Research Interest
ALS
ALzheimer's Disease
Autism
Epilepsy
Huntington's Disease
Movement Disorders
Multiple Sclerosis
Neural Repair
Parkinson's Disease
Neuroimmunology
Other
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Do you have any food restrictions of preferences?
Yes
No
If yes, describe preference for meal (vegetarian, sodium-free, etc.)
Do you require any special accommodations?
No special accomodations required
Sign Language Interpretation
Accessibility
Other
If "Other accommodation" was selected, please specify the type of accommodation required.
My Products
prev
next
( X )
3 CME credits
This activity has been approved for AMA PRA Category 1 Credit
$
Free
Conference Registration Fee
$
Free
# of Participants
0
1
2
3
4
5
6
7
8
9
10
Submit
Should be Empty: