Experts Exchange 2011 RSVP

* Title:

Other title:

* First name:

* Surname/Family name:

* Job Title:

* School/Centre:

* Institute/Faculty:

Other Institute/Faculty:

Company:

* Email address:

* Work phone:

* Primary research discipline:

* Status:

Student

Research staff member

Other

* I have attended this event before:

Yes

No

Not sure

I have special dietary requirements:

Yes

No

If yes, please provide details:

I have consulting or contract research experience with a commercial partner:

(including where, in what role and for how long, 5-10 lines maximum)

* I would rank my understanding of industry engagement issues as:

Minimal

Moderate

Advanced

Other:

* The main reason I wish to attend this seminar is:

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