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NEREID Summit Registration
June 12-14
, 2023
Delegate Information
Welcome to NERIED's 2023 Summit Registration form.
We will accept on-site registrations, but rates will be doubled.
Registration Rates:
Member: $100
Non-Member: $125
Student: $25
K-12 Teacher: $35
If you are interested in sponsoring, please email twolbrecht@aui.edu
* Indicates response to question is required.
.
Prefix
Dr.
Ms.
Mrs.
Mr.
Mx.
Other (please specify)
*
First Name
(Required.)
*
Last Name
(Required.)
Institution
*
Name on Badge
(Required.)
Preferred Pronouns on Name Badge
She/Her
He/Him
They/Them
Other (please specify)
*
Email (Primary)
(Required.)
NEREID Membership is free and provides a discount to registration. If you're interested, please review the
Benefits of Joining NEREID
and sign up today.
*
Are you a NEREID member?
(Required.)
Yes
No
Latest Project: What have you done this year? Please describe the latest major project(s) you've worked on. (
NOTE
: This information will be used by the organizers to get a better sense as to who is attending for planning purposes.)
Dietary Requests: List any dietary restrictions
NEREID is committed to making it possible for everyone to engage fully with our events. Please let us know if we can do something to support your full participation, particularly if you have concerns associated with your physical, emotional, or cognitive needs.
Summit Needs
Reserved front row seating
Wheelchair access
Lactation space
Silent space
Assistive listening device
Other sensory concerns
Other Summit Needs
Emergency contact information will only be used for internal safety purposes and will not be displayed anywhere or linked to your member record.
Emergency Contact Name
Emergency Contact Phone Number