Attendee Information
This is how your name will appear on your name badge.
Name
*
First
Last
Title/Position
Kavli Institute Affiliation (pick one)
Kavli Institute for Brain Science at Columbia University
Kavli Institute for Brain and Mind at UCSD/Salk
Kavli Institute for Neuroscience at Yale University
Kavli Institute for Systems Neuroscience at the Norwegian University of Science and Technology
Kavli Neuroscience Discovery Institute at Johns Hopkins University
Kavli Neural Systems Institute at The Rockefeller University
Kavli Institute for Fundamental Neuroscience at the University of California, San Francisco
The Kavli Foundation
Email
*
Please include a short bio (<1000 characters including spaces)...
... and a headshot to accompany your bio.
Max. file size: 4 MB.
The headshot and bio may be submitted at a later date.
Gender (optional)
Female
Male
Non-binary, genderqueer, and/or gender fluid
Prefer not to answer
Please list any dietary restrictions below. Type "none" if you have none.
*
Please request any disability accommodations below.
Childcare
We are looking into potential childcare options for the Forum. One potential option would be to provide childcare in New Haven. Another potential option would be funding to help pay for childcare-related costs necessary for you to attend this event. In order to help us research potential options, please answer the following questions:
Will you need childcare support?
Yes
No
If yes, would you prefer on-site childcare or a voucher/funding to use at your discretion?
on-site
funding/voucher
Please list the ages of the children you will need childcare for, and any other information you think would be useful for us to know.
Logistics
Will you be attending the Welcome Dinner on April 19th?
*
Yes
No
Will you be needing hotel accommodations in our room block?
*
Yes
No
We can accommodate extra nights for those traveling from outside the northeastern United States.
Requested Check-in Date
*
MM slash DD slash YYYY
Requested Check-out Date
*
MM slash DD slash YYYY
Please describe any special needs you may have for accommodations.
Scientific Abstract
Note: The organizing committee will notify you early next year if you have been selected for a poster or a talk.
Would you prefer to give a talk or a poster?
Talk
Poster
No preference
Note: we are planning to have senior faculty members participate as session moderators and/or give posters!
Abstract Title
Abstract (< 200 words)
Which branches of neuroscience best describe your area of research?
Behavioral Neuroscience
Developmental Neuroscience
Cellular and Molecular Neuroscience
Systems Neuroscience
Computational Neuroscience and Theory
Neuroengineering
You may select more than one category, or add your own below.
What branch of neuroscience, not found above, best describes your area of research?
Would you like to be part of the organizing committee?
No
Yes
We would like to get diverse representation from all 7 Kavli Institutes in Neuroscience and will be notifying you in mid-December if you have been selected.