Please provide us with the following information to register for the 2005 Langone Retreat.

Required fields are indicated with an *                                                                                                                            
Indicate N/A where Applicable                                                                                                                                         

Participant details
Type of Registrant* Member of Langone Community   (student, alum, faculty, staff, admin)
First Name* Last Name*
NYU Id* (e.g.pl491)
Street Address 1*
Street Address 2
State* Zip code*
Primary Email*
Primary Phone*
Alternate Phone*
Academic/Professional details
Core Group* Graduation Year
Job Title
Current Employer
Current Industry
Include the above information in the 2005 Langone Retreat Handbook?
Yes No
Participant preferences
Departure Time*
Type Of Cabin* Early/Late Cabin* Early
     (quiet after 11pm)
     (potentially never quiet)
Dietary Restriction* If Other,
Please Specify
Which member of Sternís faculty/staff/administration would you like us to invite to the Retreat?*
Saturday classes
Will you be attending Saturday classes at NYU?* Yes No
If Yes, specify Saturday class schedule

Additional information

Site design copyright 2005 © Langone Retreat, All Rights Reserved