Saturday, April 10, 2010 Michigan Information Technology Center 1000 Oakbrook Drive Ann Arbor, Michigan 48104
Contact Information: For questions about registration or cancellations, e-mail AGEPResearch2010@umich.edu.
Please fill out the form below by Wednesday, April 7, 2010, 5 PM (EDT)
* = required field
First name*
Middle name
Last name*
University* Michigan State University University of Michigan Wayne State University Western Michigan University
Department*
E-mail*
Status* MA/MS Student Ph.D. Student Postdoc Faculty Staff Other
If "Other," please specify* (required if status = Other)
Please indicate if you are conducting an oral or poster presentation at the symposium* Oral Poster None
Do you plan to join us for lunch?* Yes No
Please specify any dietary restrictions if applicable: (please limit 50 words)
Will you need hotel accommodations for the night of Friday, April 9, 2010?* Yes No
SUBMIT DATA - please check "confirm" and click "Submit." You will receive an e-mail confirmation and a "success" message will display on-screen when the has been submitted. confirm
