Form 1 Graduate and Professional School Fair Exhibitor Registra

GRADUATE & PROFESSIONAL SCHOOL FAIR 2016 -EXHIBITOR REGISTRATION
OMB Number: 0925-0740 (Expiration Date: May 2019)
Public reporting burden for this collection of information is estimated to average 5-minutes per
submission. 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.

The National Institutes of Health Graduate & Professional School Fair will be held on DATE at the Natcher
Conference Center on the NIH campus in Bethesda, MD. The exhibits will be open from TIME to TIME.
This fair will provide an opportunity for representatives of graduate and professional schools to meet
and recruit up-and-coming young scientists taking part in the NIH Postbaccalaureate and Summer
Internship Programs and college and university students from the Washington, DC area.
Student interest is highest in the following schools/programs: medical school, graduate school (PhD
programs in all the biomedical sciences), MD/PhD programs, public health programs, psychology, dental
school, nursing school and pharmacy school.
There is no charge to exhibit at the fair, but space is limited. Exhibitors will be provided a table and
several chairs. Please note you may be asked to share a table. Each year we have an overwhelming
response and table sharing has become the norm.
Questions?
NIH Office of Intramural Training & Education
http://www.training.nih.gov
[email protected]
301-496-2427

POINT OF CONTACT (POC) FOR THIS REGISTRATION
Title*

First Name (Given Name):*

Last Name (Family Name):*

Position Title:*

Email Address (check accuracy):*
We cannot guarantee your participation if you fail to provide a functioning email address. A
confirmation email message containing this registration will be sent to the email account
listed within 2-hours of submission.

Phone Number:*
ex: 123-456-7890

INSTITUTION / UNIVERSITY INFORMATION
Institution or University Name (complete name):

Program or Department you are representing (complete name):

Program Website (include http:// or https://):

Name of the training program as it will appear in the event program, limit 100
characters, be specific. We will not insert your university name if you omit it.
Example: "University of Alabama Dental School" or "Baylor University Graduate Program in
Biophysics"

This registration is for which type of program?
Select all that apply.
Dental
Graduate
Medical
MD/PhD
Pharmacy
Psychology
Public Health

Nursing
Other
If you selected "Other" for the Registration Type, please specify in the space
provided:

Our representative will be able to answer questions about the following programs:
Select all that apply.
Note, we will share this information with the Fair attendees.
Dental
Graduate
Medical
MD/PhD
Pharmacy
Psychology
Public Health
Nursing
Other

FIRST ATTENDEE
Is the Point of Contact for this registration also the First Attendee? *
Yes

No

Title - First Attendee:

First Name - First Attendee:

Last Name - First Attendee:

Position Title - First Attendee:

Email Address - First Attendee (check accuracy):
We cannot guarantee your participation if you fail to provide a functioning email address. A
confirmation email message containing this registration will be sent to the email account
listed within 2-hours of submission.

Phone Number - First Attendee:
ex: 123-456-7890

SECOND ATTENDEE
Title - Second Attendee:

First Name - Second Attendee:

Last Name - Second Attendee:

Position Title - Second Attendee:

Email Address - Second Attendee (check accuracy):
We cannot guarantee your participation if you fail to provide a functioning email address. A
confirmation email message containing this registration will be sent to the email account
listed within 2-hours of submission.

Phone Number - Second Attendee:
ex: 123-456-7890

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