BME Graduate Student Fair Institution Registration

Days/Events Attending*
- Friday, October 28, 2017 12pm-5pm
Robert B. Goergen Hall for Biomedical Engineering and Optics 480 Intercampus Dr, Rochester, NY 14620
Registration fee $150: A check will be requested to cover the registration expenses. If 5 students from your institution attend the event, the check will be returned.
Name: Attending representative*
First Last
Title: Attending representative*
Email: Attending representative*
_________________________________________
Separate Contact Person?*
- Yes
- No
Name: Contact Person
First Last
Title: Contact person
Email: Contact Person
Phone*
Address*
Street Address Address Line 2 City State ZIP Code