Registration – Pay by Check

Please use the form below to complete the registration process if you are paying by check. After submitting your registration information below, you will receive a confirmation message at the email address you provide. Please save the confirmation for future reference.

Please make your check payable to “Department of Epidemiology” and write “Great Plains EID Conference” in the memo field of your check.

Please mail your check within 5 days of registration to:

Department of Epidemiology c/o Marilyn Anderson
College of Public Health
University of Iowa
145 N. Riverside Dr., S441 CPHB
Iowa City, IA 52242

Registration Form

GPEID Registration 2016

Name*
First Last
Institution*
Department*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Category*
- Faculty/Professional
- Student/Postdoc or Fellow
What days do you plan to attend?*
- Friday only.
- Friday and Saturday.
Name
This field is for validation purposes and should be left unchanged.