Registration

7th International Symposium on NBIA & Related Disorders Registration

Academic registration for the conference is $45 per person.
Industry registration for the conference is $90 per person
Registration for exhibitors, authorized NBIA nonprofit representatives, and scheduled presenters is complimentary.

If your registration type requires a payment, you will be redirected to a payment screen upon submission of this form. We accept payment by credit card, debit card, or PayPal account. You do not need a PayPal account in order to submit a payment for registration online.

First Name:(*)

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(Given Name)

Last Name:(*)

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(Family Name)

Credentials:(*)

If other credentials, please list here:

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Research Institution / Company / Nonprofit Organization:(*)

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Title:(*)

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Address Line 1:(*)

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Address Line 2:

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City:(*)

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State / Province:(*)

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Zip / Postal Code:(*)

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Country(*)

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Phone:

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Email Address:(*)

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Link to Online Biography:

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(Website link to your bio, if available)

NBIA Interest (check all that apply):(*)

If other NBIA disorders, please list here:

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Current Research Focus:

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What sessions do you plan to attend?:(*)

Would you like more information about being an exhibitor?(*)

YesNo

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May we publish your online profile for all attendees to view?(*)

YesNo

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Photography Release

I grant the NBIA Disorders Association, as host of the symposium, the right to take photographs, video or screenshots, in connection with this meeting. I authorize the NBIA Disorders Association to copyright, use and publish these photos, videos or screenshots in print or electronically. I agree that the NBIA Disorders Association may use such photographs, videos of screenshots of me with or without my name and for any lawful purposes of publicity, illustration, advertising, social media (Facebook) and web content.

Consent to Photography Release?(*)

YesNo

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Type of Registration(*)

Academic Registration - 45.00 USD Industry Registration - 90.00 USD Exhibitor - 0 USD Authorized NBIA Nonprofit Representative - 0 USD Scheduled Presenter - 0 USD

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Total:

0.00 USD

Security Check:(*)

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If your registration type requires a payment, you will be redirected to a payment screen upon submission of this form. We accept payment by credit card, debit card, or PayPal account. You do not need a PayPal account in order to submit a payment for registration online.