IDSS Retail Conference 2018: MIT Internal Conference Registration Form First Name Last Name Institution Professional titlePlease select... Assistant Professor Associate Professor Professor Postdoc Research Scientist Graduate Student Undergraduate Student Other Please enter your title here: Preferred email address: Please choose your MIT department or office:Please select... Aero-Astro Biological Engineering Biology Brain & Cognitive Science Chemical Engineering Chemistry Civil & Environmental Engineering CSAIL Earth, Atmospheric & Planetary Science Economics EECS IDSS Industrial Liaison Program (ILP) LIDS Lincoln Laboratory Linguistics Materials Science & Engineering Mathematics Mechanical Engineering Media Lab MITei Nuclear Science & Engineering Physics Political Science Sloan School of Management Technology and Policy Program Urban Studies & Planning Other If your department is not part of the list above, please enter it here: If you have additional affiliations, please enter the name(s) here: MIT ID# On your conference name tag, would you like your name and affiliation displayed differently than indicated above?YesNo Name tag informationPlease let us know how you would like your name and affiliation to be displayed on your name tag for the conference. The default affiliation on your name tag will be MIT. Preferred first name: Preferred last name: Preferred affiliation description: Are you an MIT alum?Yes, I am an MIT alum.No, I am not an MIT alum. Would you like to receive the IDSS newsletter?Yes, please send me the IDSS newsletter.No, please do not send me the IDSS newsletter. Do you have any dietary restrictions? Please check all that apply.No dietary restrictionsGluten-FreeKosherVegetarianLacto-VegetarianVeganFood AllergiesOther dietary restrictions Please enter your dietary restrictions and/or food allergies here: Contact Information
