College of Medicine - University of Illinois Urbana-Champaign

College of Medicine Research Symposium

University of Illinois College of Medicine
2010 Research Symposium

Thursday, April 22, 2010
I Hotel and Conference Center, Champaign, IL
9:00 AM to 6:00 PM

Registration Form

Please fill out this form accurately—it is important that we know precisely how many to expect.

* Required fields

*First Name:

*Last Name:

Degrees/Credentials: (Optional--will appear on nametag)
i.e. MD, MPH, JD, MBA, MA, MS, MSEd, PhD, MBBS, DO, etc.

*Email:

*Department:

*Check all that apply:

MSP Student
M1 Student    
M2 Student    
M3 Student    
M4 Student
Resident     		Pre-med
Faculty
Staff
Speaker
Guest
Other

Non-faculty physician
COM Faculty
Fellow

*Will you be eating lunch at the symposium?

*Do you prefer vegetarian meals?

Simultaneous Sessions:
Please choose the simultaneous session you will be attending in the morning; we will try to accomodate all registrants. Click here for description of sessions.

Morning Session Choice

Notes to the SA/MSP Office:

 

 

 

Please PRINT a copy of your records before clicking the Submit button below.

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