Neuroscience Trials of the Future (Participants)

Neuroscience Trials of the Future: A Workshop

Please fill out the response form for our workshop, to be held on March 3–4, 2016 in Washington, DC.

1. Participant Contact Information

First Name *This question is required.

Last Name *This question is required.

Job Title *This question is required.

Organization (as it should be listed on your name badge) *This question is required.

Email Address *This question is required.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Postal Code *This question is required.

Country (if not US)

Phone Number

Fax Number

Assistant's Name

Assistant's Email

URL (if available)

2. Will you attend in-person or via webcast? (In person registration is now closed)

Lunch will be provided for participants. Do you have any dietary restrictions? If so, please describe.

Do you have any disabilities for which you require accommodations? If so, please describe.