ICMA-VIII registration form International Conference on Mathematical Modeling and Analysis of Populations in Biological Systems October 28-30, 2022 University of Louisiana at Lafayette, Lafayette, Louisiana, USA Name * Please enter your full name (first name then last name) Title (optional) Please enter your preferred title, e.g. Dr., Professor, Mr., Mrs., Ms. Badge name (for name tag) * Enter your preferred badge name "nickname" (for your name tag). Pronouns (optional) If you wish, please provide your pronouns. (If provided this will be put on your name tag.) Email address * Please enter your email address. Affiliation * Please enter your affiliation (College/University, Company, Organization, other). Include organization name and department or division name as appropriate. Mailing address * Please enter your mailing address. Save the city and state/province information for the following text area. City * Please enter the name of your city. State/Province * Please enter your state or province. Zip code/Postal code * Please enter your zip or postal code (write none if not applicable). Country * Please enter the name of your country. Telephone number * Please enter your telephone number (include country code for non USA/Canada numbers). Attendee profile * Please indicate the option which best describes your current position. College/University Faculty Post-Doc Graduate Student Undergraduate Student Business, Industry, or Government Other Are you giving a talk? * Please indicate whether you are giving a talk. yes no Are you presenting a poster? * Please indicate whether you are presenting a poster. yes no Time and date of arrival (optional) Please provide your (estimated) arrival time and date. Time and date of departure (optional) Please provide your (estimated) departure time and date. Ethnicity (optional, used for reporting purposes only) Please enter your ethnicity. Select all that apply. Optional, used for reporting purposes only. American Indian or Alaska Native Asian Black or African American Hispanic or Latino Middle Eastern or North African Native Hawaiian or Other Pacific Islander White Other race, ethnicity, or origin Gender (optional, used for reporting purposes only) Optional, used for reporting purposes only. Please indicate your gender. You may select more than one option. Male Female Prefer not to share I am writing my gender in the space provided below Gender description (optional, used for reporting purposes only) If none of the options above were appropriate, please supply gender here. Dietary restrictions (optional) If you have any dietary restrictions, please describe them. Special requests or needs (optional) If you have any special requests or needs, please describe them. Leave this field blank