Registrant Netid:                   Faculty Member Netid:

• If you are a faculty member, enter your netid in BOTH fields above.
• If you are a student or staff, and your attendance is related to a faculty
  research project or a course, please provide the faculty member's Netid.
  Otherwise, you may leave the Faculty Member Netid field blank.

E-mail address:    

Registrant Academic Status: -- Please select an academic status -- affiliate unknown Academic Staff Undergrad Grad Student Retiree Faculty Non-Cornell alumni

Registrant College: -- Please select a college -- A&S AAP CALS CHE CIPA CIS CISER ENG GR ILR JGSM LAW MED Other ROTC SCE SHA VET

Registrant Department/Field: -- Please select a department --

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