Registration Form

Registration Form
Micro-clinic on Introduction to Unicist Strategy Building

Please fill out all fields on this form to complete your academic registration. You will be asked to choose the date in which you will be participating. Remember that you will participate both in a micro-clinic and in a Question Answering Session. After you submit this form you will be redirected to complete the registration process through the payment procedure.

Title:

Name:

Last name:

Please choose the date that is more convenient for you.

January

Micro-clinic: January 12, 2009 - Time: 9:00 am to 10:00 am (NY Time)
Question Answering Session: January 14, 2009 - Time: 9:00 am to 10:00 am (NY Time)

Micro-clinic: January 12, 2009 - Time: 6:00 pm to 7:00 pm (NY Time)
Question Answering Session: January 14, 2009 - Time: 6:00 pm to 7:00 pm (NY Time)

February

Micro-clinic: February 9, 2009 - Time: 9:00 am to 10:00 am (NY Time)
Question Answering Session: February 11, 2009 - Time: 9:00 am to 10:00 am (NY Time)

Micro-clinic: February 9, 2009 - Time: 6:00 pm to 7:00 pm (NY Time)
Question Answering Session: February 11, 2009 - Time: 6:00 pm to 7:00 pm (NY Time)

March

Micro-clinic: March 9, 2009 - Time: 9:00 am to 10:00 am (NY Time)
Question Answering Session: March 11, 2009 - Time: 9:00 am to 10:00 am (NY Time)

Micro-clinic: March 9, 2009 - Time: 6:00 pm to 7:00 pm (NY Time)
Question Answering Session: March 11, 2009 - Time: 6:00 pm to 7:00 pm (NY Time)

April

Micro-clinic: April 13, 2009 - Time: 9:00 am to 10:00 am (NY Time)
Question Answering Session: April 15, 2009 - Time: 9:00 am to 10:00 am (NY Time)

Micro-clinic: April 13, 2009 - Time: 6:00 pm to 7:00 pm (NY Time)
Question Answering Session: April 15, 2009 - Time: 6:00 pm to 7:00 pm (NY Time)

e-mail:

Country:

City:

Profession:

Activity:

Phone:

-Please indicate your country code

Company:

Unicist Knowledge Center (City) :

-Indicate "No" if you have none.

Date of Birth:

Please indicate your main reason for participating:

I am interested in receiving information on new scientific developments:

PRIVACY POLICY: We at The Unicist Research Institute know how important it is that the information about you is used in an appropriate way. Your information will never be released, rented or sold to any other persons, organizations or companies. We will never collect any information about you without your prior knowledge, our information is collected using lawful methods as set by the Data Protection act of 1998.