Workshop Registration Form

DIMACS/Northeast Big Data Hub Workshop on Privacy and Security for Big Data

April 24 - 25, 2017

Please fill out the following form to register. Required fields are marked with *.

When finished and you have checked the correctness of information, press the "send" button at the bottom of the form.

Attendance is limited to available space; please register early. 

       






           Your First Name: 
           *Your Last Name: 


            *Your Position: 



Your Postal Address: (This information will be used for nametags & mailing lists)
      Name of organization: 
                            (University or Company Name)


        *Organization Type:  
                Department: 
            Street Address: 
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                     Phone:  
                       Fax: 
                   *E-Mail: 
              Web page URL:

Comments: (i.e. dietary restrictions, request for travel support)


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