Example form

Academic Conference Registration

To attend the academic conference, please register below.

"*" indicates required fields

Name*

Title First Name Last

Email*

Affiliation*

Job Title*

Dietary Requirements*

None

Vegetarian

Pescatarian

Vegan

Gluten Free

Other

Will you attend the conference dinner on 20th April?*

Yes

No

Maybe

Mobility Requirements

Please contact me regarding my mobility requirements

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