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REGISTRATION
Fall meeting of Statlab 2020
September 28, 2020
* MANDATORY FIELDS
IDENTIFICATION*
TITLE*
Ms
Mr
Dr
Professor
Professor Dr
NAME*
Given Name
Family Name
OCCUPATION*
FACULTY/RESEARCHER - WITH GRANT
FACULTY/RESEARCHER - WITHOUT GRANT
POSTDOCTORAL FELLOW
GRADUATE STUDENT (2ND AND 3RD CYCLE)
UNDERGRADUATE STUDENT
ELEMENTARY OR SECONDARY SCHOOL PROFESSOR
INDUSTRIAL RESEARCHER (Industry, Finance, etc.)
UNEMPLOYED
SELF-EMPLOYED
Other
Gender* (for statistical purposes)
Female
Male
Prefer not to answer
Language of correspondence*
English
Français
AFFILIATION*
Affiliation
Department
Address of Affiliation
City
Postal Code / Zip Code
Please choose a country:
Please choose a state, province or area:
CORRESPONDENCE ADDRESS
Please fill out the following if different from the affiliation.
Correspondence address
Address
City
Postal Code / Zip Code
Please choose a country:
Please choose a state, province or area:
TELEPHONE (with dialing code), EMAIL ADDRESS AND WEB SITE
Email address*
Secondary email address
Office phone*
Home phone
Fax
Cellular Phone
Web Address
Twitter
ACCOMMODATION
Would you like the CRM to reserve a hotel room for you?
Yes
No
Hotel
(
list of hotels
)
First hotel choice
Second hotel choice
Occupancy
Single room
Double room
Hotel arrival date
DD/MM/YYYY
Hotel arrival time
HH/MM
Hotel departure date
DD/MM/YYYY
MISCELLANEOUS INFORMATION
Please write any other information or comment.
