Conference Application Form

In order to achieve the goals of the conference, there is a limit as to the number of participant who will be accepted. Thus, submission of the conference application form does not guarantee acceptance to the conference. Preference will be given to applicants who present at the conference. If space is still available, preference will be based on a first-come basis. As a result, students are encouraged to submit an application as soon as possible before the April 1, 2012 deadline for proposal submission and conference application. Applicants will be notified on or before April 30, 2012 as to whether their proposal submissions and/or their applications have been accepted. Accepted applicants will have until May 5, 2011 to confirm their acceptance of the invitation to participate in the conference by paying in full their conference registration fee.

Please complete and submit the Conference Application Form.

Conference Registration     Name:  College or University:  Mailing Address:  Home Phone:  Alternate/Cell Phone:  E-mail Address:  Are you submitting a presentation proposal for the conference? Yes   No   Title of Presentation (limited to 100 characters including spaces)

1st Author of Proposal:

2nd Author of Proposal:

3rd Author of Proposal:

4th Author of Proposal:

Abstract of Presentation (limited to 250 words)

File Upload:

Submission Format Preference:

Paper

Poster

Lodging Registration

Are you requesting lodging for the conference? 

Yes

No

What is your gender? (for roommate purposes) ? 

Male

Female

Do you need a smoking room? 

Yes

No

Do you need special room accommodations for any reason, e.g., physical disabilities?

Yes

No

If so, please explain.


Do you have a preferred roommate?

Yes

No

If so, what is his/her name?


Do you have any food allergies or Dietary Restrictions?

Yes

No

If so, please explain.

     

Conference Registration Fees $100.00/ $75.00 (without housing)

UPON NOTIFICATION OF ACCEPTANCE, ALL REGISTRATION FEES MUST BE PAID BY CHECK OR MONEY ORDER. PLEASE MAKE ALL CHECKS PAYABLE TO "Loyola Marymount University". REGISTRATION FEES CAN BE SENT TO:

National Black Graduate Conference in Psychology
c/o Dr. Cheryl Grills
University Hall
Loyola Marymount University
One LMU Drive, Suite 4600
Los Angeles CA 90045-2659

PAYMENT MUST BE RECEIVED BY 11:59PM EST ON FRIDAY, MAY 5, 2012 TO CONFIRM CONFERENCE REGISTRATION.