Conference Registration

Please complete and submit the form below by
April 2, 2010

Conference Registration     Name:  College or University:  Mailing Address:  Home Phone:  Alternate/Cell Phone:  E-mail Address:  Paper and Poster Registration   Title of Presentation (limited to 100 characters including spaces)

Abstract of Presentation (limited to 250 words)



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.

     

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

National Black Graduate Conference in Psychology
c/o Shawn Bediako, Ph.D.
Department of Psychology
University of Maryland, Baltimore County
1000 Hilltop Circle
Baltimore, MD 21250-0001