Student Registration

1. First Annual Neuroscience Graduate Group Retreat

The Academy of the Natural Sciences
1900 Benjamin Franklin Parkway
http://www.ansp.org/

Friday, October 24, 2008

Please provide your contact information: 1. Name
2. Email
3. Lab Name (thesis or rotation)

	Please select one
Class of	Please indicate your entrance year into grad school Class of Please select one

	Graduate Group	Department
Please select one in each drop-down menu	Please indicate your Graduate Group and Department Please select one in each drop-down menu Graduate Group	Department

Other Department (please specify)

	Please select one
PRIMARY area of interest	Please indicate your PRIMARY area of interest in neuroscience PRIMARY area of interest Please select one

	Yes	No
Breakfast	Will you be attending Breakfast Yes	No
Lunch	Lunch Yes	No
Reception	Reception Yes	No

Would you like to present a poster? (potential to interact with museum vistors!) Yes

Would you like to be considered for a 15min presentation? Yes

Or nominate a friend!

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