Name *

First Name

Last Name

Which days of the symposium are you planning to attend? *

Select all that apply.

Tuesday, May 21 (1-5pm) - Neurodevelopment Session & Keynote Address

Wednesday, May 22 (9am-1pm) - Pain & Addiction Session

Wednesday, May 22 (1-5pm) - Brain Aging Session & Poster Session

Thursday, May 23 (9am-1pm) - Keynote Address & Epilepsy Session

Thursday, May 23 (1-5pm) - Neuroimmunology Session

If you are a trainee, do you plan to attend the Neuroscience Trainee Career Lunch on Wednesday, May 22nd?

Undergraduate, graduate, & medical students as well as postdoctoral scholars are welcome to attend.

Yes

No

For all attendees, do you have any dietary restrictions?

Select all that apply

Vegetarian

Vegan

Gluten-free

Dairy-free

Allergies

There will be an event photographer at the symposium and your picture may be taken. Do you give us permission to publish the photos that may be taken of you at the event for promotional purposes? *

Yes, I give permission to the UVA Brain Institute to take my photo during event activities and use it in the future.

No, I decline my permission. I understand that it will be my responsibility to contact the UVA Brain Institute if I wish to have my photo removed from their website or other materials.