Research Day Registration Form

Registrant Profile


Number of years in profession
What best describes your role in the profession?
How did you hear about this event?
Preferred format for program and meeting information

Personal Information

Name:
Name Preference for Badge:

Institution:
Address:
Phone:
Fax:
E-mail Address:
Twitter Account @

Conference Registration

Type of Attendee

Special Events/Activities

Check the events you will be attending:


If you plan to pay with Credit Card, please provide the last four digits of your credit card, the type of card you will be paying with and the card's expiration date so that we may track your payment in the event of problems.
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Please read our Cancellation Policy

Abstract

Please read the Criteria for Abstract Submission before submitting a document. Select the document that you want to upload below. It will be uploaded at check-out upon completion of this form. The deadline for abstract submissions has been extended to April 29, 2013.

Would you like to participate in Research Forum?
Forum Document:

Photo Release

From time to time JPS uses photographs of event participants in our promotional materials. By virtue of your attendance at JPS events, we reserve the right to use your likeness in the association's written publications, videos, and/or website, unless you have specifically denied permission by checking the box below.

JPS will not sell or otherwise use this material for commercial purposes. Please note that it is your responsibility to avoid being photographed in large group pictures during events at the conference if you are denying permission to use your likeness. Implied consent is granted if the following box is NOT checked.