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Contact Info

First Name:*
Last Name:*
Please tell us where you would like the registration packet sent.
Address:*(Street and Number or PO Box)
Address 2:(Suite or Apt)
City:*
State:*(2 letter abbreviation, i.e. FL, IN)
Zip Code:*
Country:(If ouside United States only)
E-Mail Address:*
Verify E-mail:*
Phone Number:*(Please include area code.)

Organization Info
Please select your organization. The lists are grouped by Academia, Consulting, Government and Industry. If you do not see your organization, please select "Other" and fill in box to the right.
CHOOSE ONLY ONE.
Academia:Other:
Consulting:Other:
Government:Other:
Industry:Other:

Event Info
Short Courses Available: (Select 1 Short Course below)
     An Introduction to Biomarkers for Statisticians - A Brief Guide to Utilizing the Most Appropriate Analytical Tools - Ena Bromley and Lin Li, BSSI
    Accelerating Drug Discovery Through Precision Medicine and Innovative Designs - Sandeep Menon and Weidong Zhang, Pfizer
    
Registration and/or Course cost:
If you selected the short course above, please select which you will attend:
Indicate which events you plan to attend:
Monday Lunch Monday Night Mixer [Details] Tuesday Lunch
Tuesday Night Banquet Wednesday Lunch
Buddy system between students and professionals. Please select one. [Details]
I am a student and wish to be paired with a professional to learn about statistician professional experiences.
I am a professional and wish to be paired with a student to mentor them about statistician professional experiences.
Neither - I am not interested in the Buddy System.

Seeking Judges [Details]
I am interested in helping to judge the student poster competition (expected 1 hour commitment).

Payment Info
Please select a Payment Method: (Note in most cases the waiver only pays for registration if you have a waiver and are electing to take the short course, please select a method of payment.)
Pay onsite. Cash, Check, or money order ONLY!
Mail a personal or company check or money order (Please be sure your name is on the check.)
Credit Card (Only available on-line. Credit cards will not be accepted on-site.)

Waiver Info
PRE-APPROVED Waiver or Grant for the registration fee (does not include short course)
Note: Please only check this if you have clear confirmation from an MBSW organization member
If have received a confirmation please do not submit again.
If you are having troubles please contact: support@mbswonline.com