Symposium RSVP

Name*

First

Last

Division, Department, or Academic Unit (you represent):*

Are you able to attend the Symposium? *

Please select Yes or NoYesNo

Please write the location where you will be participating in the DEI Symposium:

If you are unable to attend the Symposium, who will be in attendance in your place?

First

Last

Do you want a boxed lunch?

Please choose:YesNo

Do you have any dietary allergies or restrictions?

Please choose:YesNo

Please provide information about your allergies and food restrictions:

Best contact E-mail address:*

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