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Please provide us with the following information to register for the 2006 Langone Retreat.

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

Participant details
Type of Registrant *  
NYU ID (e.g. pl491) * (your NYU ID)
First Name *
Last Name *
Gender * Female  Male
Street Address 1 *
Street Address 2
City *
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 2006 Langone Retreat Handbook?
  Yes No
Participant preferences
Getting There *
Type of cabin *  
Early/Late Cabin * Early (quiet after 11pm)
Late (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
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