NISS/ASA Writing Workshop
for Junior Researchers Registration
Fields in
BOLD
are required.
Registration Information
Prefix
Capt.
Dr.
Hon.
Lt.
Maj.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
First Name
MI
Last Name
Affiliation
Degree Year
Gender:
Choose One
Male
Female
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Ethnicity: Are you Hispanic or Latino?
Choose One
Yes
No
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Race:
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American Indian or Alaska Native
Asian
Black, African American
Hispanic/Latino/Latina
Native Hawaiian or Pacific Islander
Other
White
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Email
Funding?
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Need Funding
Do Not Need Funding
Please indicate any
dietary restrictions.
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Heart Healthy
Kosher
Vegetarian
None
You agree to attend all sessions and to revise document while at JSM.
Questions?
Email Keith Crank