FRIDAY, OCTOBER 25, 2019 · 8 AM TO 12:30 PMMedical and Translational Research (MART) Building Auditorium, Stony Brook University Hospital Please complete the following form to register: Affiliation/Organization/Institution & Department: * First Name: * Last Name: * Prefix Miss Mrs. Ms. Mr. Dr. Title * Primary Phone: * Please enter as XXX-XXX-XXXX Email: * Example: email@example.com Verify Email: * How did you hear about Meeting of the Minds? * Email Website Flyer Poster Facebook Twitter Other If Other, please indicate what: Street Address: * Street Address Line 2: Street Address Line 3: City: * State: * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Postal/Zip Code: * Country: * Select your Attendee type: (Valid Student Photo ID is required at the door for Students): * Stony Brook Faculty or Staff Residents/Fellows/Graduate Students Undergraduate Other If Other, please indicate what: Disclaimer: Photographs and/or videotape taken during the course of this event may be used in future advertising and promotion of Stony Brook University and/or Stony Brook Medicine. CAPTCHAThis question is to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.