Attendee Registration Form

Registration Type*

First Name (this will be listed on your name badge)*

Last Name (this will be listed on your name badge)*

Institution/Organization (this will be listed on your name badge)*

Primary Affiliation (this will be listed on your name badge)*

Primary Role in the IDeA Programs (this may be designated on your name badge)?*

Work Phone Number *

Phone

Cell Phone Number

Phone

Terms & Conditions*

I accept the

Email*

City*

State*

Zip Code*

Street Address*

Food and Meal Planning

To help us plan for food and meals during NISBRE2024, please provide answers to the following questions:

Do you have any specific dietary restrictions or preferences? *

Yes

Do you plan to attend the Welcome Reception on Sunday evening (June 16, 4:30-6:30PM ET)? *

Yes

Undecided

Do you plan to attend the Lunch and Awards Ceremony on Wednesday afternoon (June 19, 12:00-1:30PM ET)? *

Yes

Undecided

Registration Details

Please indicate which workshop, meeting, or breakout session you plan to attend for each day. You are not required to attend the session you select during registration. This information helps us ensure that sessions are assigned to rooms based on room occupancy.

Discount Coupons:

Packages Included:

Total Amount:$300.00

Provide the name and email address of Cardholder/Payer:*

Note: Please enter both the name and email of the cardholder in this single field, separated by a comma.