UCSD REGISTRATION: Parkinson's Disease: Empowering the Community

Saturday March 11, 2017

Irwin M. Jacobs Qualcomm Hall

5775 Morehouse Drive

San Diego, CA 92121

9am - 4pm

FREE parking available

*Please note: a confirmation/wait list email will be sent within 24 hours of registration. If registration is submitted over the weekend, expect to receive confirmation the next business day.

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* 1. First Name

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* 2. Last Name

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* 3. I am a

Patient

Family Member

Other

Other (please specify)

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* 4. Email Address

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* 5. Address (street, city, state, zip)

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* 6. Additional Attendees' Names

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* 7. I have the following questions for the speakers

Question 1.

Question 2.

Question 3.

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* 1. First Name

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* 2. Last Name

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* 3. I am a

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* 4. Email Address

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* 5. Address (street, city, state, zip)

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* 6. Additional Attendees' Names

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* 7. I have the following questions for the speakers

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* 8. How did you hear about our event?