Symposium Registration

First Name

Last Name

Credentials

Name of University

How do you want your name printed on your badge?

Email Address

Your Cell Phone Number

Name/University/Department that Should Appear on $10,000 eCheck
(up to 45 characters)

Email Address to send $10,000 eCheck

List the names and emails of each faculty member attending the Symposium.
We will email an $800 travel stipend for each faculty member after the Symposium (by June 30th). The checks will be made out to the SLP.

I understand that checks will not be reissued.
(Enter your name to confirm your understanding.)