Registration

PLEASE NOTE: The materials distributed to workshop attendees will include a list of all attendees, their organizations, and their email addresses. No other information will be provided, and the information will not be posted online or otherwise distributed.

First name:

  

Last Name:

Name as it should appear on badge:

Title:

Organization:

My principle area of interest is:
Disease modeling
Disease surveillance
Disease response
Other (please specify):

Address:

City:

State:

  

ZIP:

Phone Number:

Fax:

Email:

I DO NOT want to share my email address with other meeting attendees.

Will you need access to the NCSA wireless network during the workshop?
Yes
No

Which meals will you be attending?
Continental breakfast on Sept. 7
Lunch on Sept. 7
Evening reception on Sept. 7
Continental breakfast on Sept. 8
Lunch on Sept. 8

Do you have any other special needs (dietary requirements, assistance due to a disability, etc.)?

Will you be contributing a poster to the poster session?
Yes
No


If you have any other questions or need assistance, please contact Jay Roloff at jroloff@ncsa.uiuc.edu or 217-244-0223.

 

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