2016 CU²MiP

Registration Form

First Name

Last Name

Race

If you selected "other", please indicate:

Ethnicity

Are you a first generation college student?

Yes

Gender Identity

If you selected "other", please indicate:

Institution Name (i.e. your current university/college)

Undergraduate Major(s) or Intended Major(s)

If you selected "other", please indicate:

I plan to attend the National Institute for Standards and Technology (NIST) lunch and tour on Friday, Oct. 7th, and I understand that in order to attend the visit to NIST I must be at the Inn and Conference center no later than 10:30 AM.

Yes

I plan to attend the UMD Lab tours on Sunday, October 9th, from 3-5 pm.

Yes

Accomodations Information

Is there another student attending this conference you would like to room with? If so, please provide their full name (First and Last). We will try to accommodate all requests.

Requested Roommate

If you have any dietary restrictions, please list them below:

Please list any dietary restrictions

In the text box below, please list anything else about you that you want the conference organizers to know in order to facilitate your participation in CU2MiP. (E.g., medical condition, need for handicap accessibility, etc.)

Additional Information

I would like to present a poster at this conference. (This is not required, but highly encouraged!) Additional information about the poster session can be found here.

Yes

I would like my email included in the published conference participant list.

Yes

Registration Form

Thank you!