15th Annual Science Conference - Friday, March 2, 2012

Sponsored by NSF/AGEP and the Office of the Provost

Oral Presentation Submission Deadline: February 13, 2012
Registration Deadline: February 17, 2012
Poster Presentation Submission Deadline: February 20, 2012






To register, fill-in the form below. The registration process consists of 3 steps. Only fields marked with a red asterisk ( * ) are required. If you need hotel accomodations, please indicate so in the appropriate fields.

REGISTRANT INFORMATION
I'm Registering as a(n):	Student Faculty Administrator Presenter Guest *
Salutation	Ms. Mrs. Mr. Dr. *
First Name	*
Last Name	*
Email Address [?]	*
INSTITUTION INFORMATION
Institution/Campus
Department	*
Title
Academic Level	Undergraduate Masters Doctoral Post-doctoral N/A *
Program Affiliation	AGEP IGERT LSAMP MARC MBRS MC NAIR MARC RISE OTHER N/A *
TRAVEL ACCOMODATIONS
Will you need a hotel room?	Yes No
CONFERENCE ATTENDANCE
Which days and times will you be attending?	Friday, March 2nd, 9:00am - 5:00 pm Breakfast Lunch
Comments/ Special Dietary Requests

Disclaimer:
Photographs will be taken throughout the conference. Your registration on the CUNY AGEP website indicates your approval for us to use your image in AGEP Program promotional materials.

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