Symposium on Multidisciplinary Approaches to Understanding the Mind and Brain

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Symposium on Understanding the Mind and Brain (SUMB)

Marriott Hotel, University of Arizona, Tucson, Arizona

May 9-11, 2010

Registration Form for SUMB

Attendee's Background Information Attendee's Salutation Attendee's First Name (Given Name) Attendee's Last Name (Family Name) Attendee's Affiliation Attendee's AddressAttendee's Email Address Attendee's Telephone (optional) Attendee's Fax (optional) Attendee's Website (optional)

Attendee's Presentation Preference Do you plan to make a technical presentation?

Please fill out the remaining of this section if you answered 'yes' to the previous question.

Title of the Presentation Abstract of the PresentationShort-bio of the PresenterLength of the technical presentation?

More Information Do you plan to stay at the Marriott Hotel, the official hotel of SUMB? Will you be driving to SUMB? Do you have any special dietary restrictions for the banquet? Other special requests

Payment Information

A banquet/reception and conference fee of $100.00 will be due when you check in on-site. You may pay it by cash or a check. No credit card will be accepted.

Final Confirmation

I agree that the information provided in this form is truthful, to the best of the attendee's knowledge.

I have read the above agreement?Please type 'agree' here