GM XV: Registration Form

Registration Form
Dear Genomic Medicine XVI Attendee:

Thank you for your participation in the upcoming meeting, Genomic Medicine XVI: Host Genomics and Infectious Diseases, organized by the NHGRI Genomic Medicine Working Group and the National Institute of Allergy and Infectious Diseases. The meeting will be held December 12-13, 2024 at the Bethesdan Hotel in Bethesda, MD.

You must complete this form for your meeting attendance (in-person and virtual) by Friday, October 25.
Meeting Registration Information
Name*

FirstLast
First Name for Badge and Tent Card*
Degree*
Professional Title*
Organization*
Office Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
Office Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Conference Attendance
I will attend:*

In Person - Both DaysIn Person - Thursday, December 12 onlyIn Person - Friday, December 13 onlyVirtually (link will be distributed prior to meeting)
Note: The link to attend virtually will be distributed to all attendees prior to the meeting. If you only plan to attend in person one day, you are welcome to join virtually on the other day.
If you plan to attend in person, please specify your food allergies and sensitivities (check all that apply):

Gluten intolerance or sensitivityShellfish allergyLactose intolerance or dairy allergyPeanutsTree nutsSoyOther
If you plan to attend in person, please specify your dietary choices (check all that apply):

VegetarianVeganNo red meatNo pork
Should be Empty:

Registration Form

Meeting Registration Information

Conference Attendance