ICAP Summer Workshop Registration: June 6-7
I-CAP Summer Registration: June 6-7
Due to limited space at the workshop, your registration will need to be confirmed. You will receive a confirmation email notifying you of your status no later than Monday, May 27.
1. What day(s) will you be able to attend?
Thursday, June 6
Friday, June 7
Both; June 6 & June 7
2. First Name
3. Middle Initial
4. Last Name
5. Campus Mailing Address (please include 3 digit Mailcode)
6. Phone Number (w)
answer must be phone number with area code like 217-333-1000
answer must be an email address
9. Ethnicity - Please indicate if you are:
Hispanic or Latino
Not Hispanic or Latino
10. Race - Please indicate if you are:
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
11. Gender - Please indicate if you are:
12. Affiliation - Please indicate if you are:
ICAP graduate fellow
Enter text for question 12 other
13. If you are a graduate or undergraduate student please list your primary faculty advisor:
Please indicate any dietary restrictions:
14. Please indicate any dietary restrictions:
The event will be held at the University of Illinois Urbana-Champaign, Beckman Institute for Advanced Science and Technology, 405 N. Mathews, Urbana, Illinois 61801. Details on room location will be sent via email to registered attendees.
If you have any questions please contact Meghan Fisher at email@example.com or 217-300-2205.
For more information on I-CAP visit:
Enter email address
to receive a copy of this Form.
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