DMICC Workshop on Opportunities for Research Supported by the Special Statutory Funding Program for Type 1 Diabetes Research

OMB No.: 0925-0740
Expiration Date: 09/30/2025

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Registration

This meeting will be in-person for panel and presenters, with a webcast for virtual attendees. Virtual attendance is available for audience members. Webcast information, when available, will be sent to the email you provide below.

* First Name

* Last Name

* Email

* Degree

TIP: Hold the CTRL/Command key while clicking to select more than one degree

* Institution

* Attendance

In person

Virtual

Pre-ordered box lunches are available for convenient delivery on the day of the meeting. Box lunch purchase is not required. All boxes shall consist of a choice of sandwich and beverage plus chips, fruit, and cookie. All box lunches cost $17.50. After submitting this form you will be asked to provide credit card information, and your card will be charged immediately. NOTE FOR PANELISTS AND PRESENTERS: A working lunch is expected, so pre-purchasing a box lunch is highly encouraged.

* Sandwich Selection

Uptown Turkey Avocado: oven-roasted turkey, bacon, avocado, lettuce, tomato, mayonnaise

Chicken Pesto: grilled chicken, tomato, arugula, pesto* aioli, house vinaigrette

Carved Ham & Swiss: pecan wood smoked ham, Swiss cheese, tomato, red onion, stoneground mustard

Tomato Mozzarella: fresh mozzarella, tomato, roasted red pepper, arugula, basil, balsamic vinaigrette

None

Beverage

Coke

Diet Coke

Sprite

Bottled Water

I understand that meeting materials such as name badges, tent cards, and participant lists may be prepared using the exact contact information as entered on this form.

Please review and correct any capitalizations, typographical errors, etc. before submitting this form.

Payment Required: $0.00

None
Ph.D.
Pharm.D.
Dr.P.H.
Dr.Ed.
D.D.S.
M.P.H.
M.P.P.
M.H.S.
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M.S.N.
M.S.P.H.
M.Ed.
M.D.
D.O.
M.B.A.
M.A.
J.D.
D.V.M.
D.Sc.
B.S.N.
B.S.
B.A.
A.A.