Event Registration Form

Name(Required)

First Last

Preferred Name

Please tell us your preferred name if different from your entry above.

Email(Required)

Phone Number

Affiliation/Organization(Required)

Dietary Restrictions

Do you require any accommodations for accessibility purposes at this event?

Do you plan to attend the workshop dinner at 5:00 PM on June 9?

Yes

No

May we contact you about future events, opportunities, etc. at the Prindle Institute?

Yes.

No.