ISI Form

1. Name of Student Contact person *This question is required.

2. Email of Student Contact person *This question is required. This question requires a valid email address.

3. Telephone number of Contact person *This question is required. This question requires a valid number format.

4. Names of students in group (up to 5)

Student 1 *This question is required.

Student 2 *This question is required.

Student 3

Student 4

Student 5

5. Name of staff member contact

6. Email of staff member contact *This question is required. This question requires a valid email address.

7. Telephone number of staff member contact *This question is required. This question requires a valid number format.

8. University Name *This question is required.

9. Street Address *This question is required.

10. City *This question is required.

11. State or Province *This question is required.

12. Country *This question is required.

13. Postal Code *This question is required.

14. Degree program(s) of student in group *This question is required.

15. Title of proposed poster *This question is required.

16. Abstract of proposed poster *This question is required.

17. A letter of support from your National Statistical Society or ISI Outreach Committee may be attached here.

18. Please indicate that you have read the terms and conditions. *This question is required.