Registration

OMB No.: 0925-0740
Expiration Date: 9/30/2025

Collection of this information is authorized by The Public Health Services Act, Section 410 (42 U.S.C. § 285 : US Code - Section 285: Purpose of Institute). Rights of applicants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not submitting this information. Refusal to participate will not affect your benefits in any way. The information collected will be kept private to the extent provided by law and only made available to other meeting attendees. The information gathered through this registration page will help the conference organizers plan the meeting.

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0740). Do not return the completed form to this address.

This meeting is by invitation only.

Please complete the following form to register for the 2024 Professional Development Workshop and Mentored Mock Review.

Registration Deadline: Monday, May 6, 2024

If you need to update your registration, please click here.
You must use your official registered email address to access your registration.

Contact Information

*Denotes a Required Field.

*Prefix:

Prefix is required.

Other Prefix:

You selected 'Other' for Prefix.
Please enter some explanatory text.

*First Name:

First Name is required.

Middle Initial:

*Last Name:

Last Name is required.

*Degree(s):

Degree is required.

Other Degree:

You selected 'Other' for Degree(s).
Please enter some explanatory text.

*Title:

Title is required.

Division:

*Affiliation:

Affiliation is required.

*Address 1:

Address is required.

Address 2:

*City:

City is required.

*State/Province:

State/Province is required.

*Country:

Country is required.

*Postal Code:

Postal Code is required.

A valid Postal Code is required.
(Format: XXXXX or XXXXX-XXXX).

*Phone:

Phone is required.

Phone Ext.:

*Email:

A valid Email is required.

Assistant Information

*Denotes a Required Field.

First Name:

Last Name:

Phone:

Email:

A valid Assistant's Email is required.

Career Level

*Denotes a Required Field.

*Please select your career level. Non-grantees should select "Not Applicable."

*Career Level:

A Career Level selection is required.

Funding Mechanism

*Denotes a Required Field.

*Please select your funding mechanism. Non-grantees should select "Not Applicable."

*Funding Mechanism:

A Funding Mechanism selection is required.

*Other Funding Mechanism:

You selected 'NCI Multiple awards' for Funding Mechanism. Please enter a list of the funding mechanisms.

You selected 'Other' for Funding Mechanism. Please enter some explanatory text.

Mentored Mock Review

*Denotes a Required Field.

*Please select if you will be attending the Mentored Mock Review Workshop (Friday, June 7, from 12:30 to 4:20 p.m.):

Yes, I will attend as an observer.

Yes, I am an invited reviewer and will attend.

No, I will not attend.

A Mentored Mock Review selection is required.

Mentored Mock Review Confidentiality Agreement

*Denotes a Required Field.

To participate in the Mentored Mock Review Workshop, you are required to read the confidentiality agreement and type your full name below to serve as an electronic signature.

Click here to review the confidentiality agreement.

By typing your full name below, you certify that you agree to all statements presented within the confidentiality agreement:

You must electronically sign the confidentiality agreement in order to attend the Mentored Mock Review.

Special Accommodations

If you require assistive services or other reasonable accommodations (nursing room, interpretation, CART service, etc.) to participate in this workshop, please list them below or email Ms. Michelle Murray at conferences@luminacorps.com to discuss your needs. Please notify Ms. Murray at least 10 days before the workshop.

Special Accommodations

2024 Professional Development Workshop and Mentored Mock Review

June 6–7, 2024

Registration

2024 Professional Development Workshop and
Mentored Mock Review