College Of Medicine
University of Illinois Urbana-Champaign

*First Name:

*Last Name:

Degrees/Credentials: (Optional--will appear on nametag)
i.e. MD, MPH, JD, MBA, MA, MS, MSEd, PhD, MBBS, DO, etc.

*Email:

*Department:

*Check all that apply:

MSP Student M1 Student     M2 Student     M3 Student     M4 Student Resident

Pre-med Faculty Staff Speaker Guest Other

Non-faculty physician COM Faculty Fellow

*Will you be eating lunch at the symposium? Yes No

*Do you prefer vegetarian meals? Yes No

Simultaneous Sessions:
Please choose the simultaneous session you wiill be attending in the morning; we will try to accomodate all registrants. Click here for description of sessions.

Session 1 (8:30 AM to 9:45 AM)

Session 2 (10:00 AM to 11:15 AM)

Notes to the SA/MSP Office:

The following questions are optional, but high recommended. The Social/Arts committee is seeking quotes from attendees to display anonymously at the research symposium. Quotes can be a word long to a paragraph. Your responses are appreciated in making the 2007 Research Symposium more exciting.

What does Collaboration, Innovation and Translation in Medicine mean to you?

What are your thoughts on technology and advancement in medicine and clinical research?

Please PRINT a copy of your records before clicking the Submit button below.