Otro Corazón 2: Symposium Participant Information

Slightly modified "Essence" Theme

Otro Corazón 2: Symposium Participant Information
I. Basic Participant Information
Full Name
Symposium Role
Email Address
Contact Number
How would you prefer we contact you?
Do you have any dietary restrictions? Please describe
Do you have a social media presence? Please indicate platform (Facebook, Twitter, Instagram, etc) and username(s)
Upload Your CV Here (.doc or .pdf)
Upload Your Bio Here (.doc or .pdf)
Upload Your Photo Here (.jpg or .png)
II. Travel/Lodging Information
Do you plan to stay at the UCLA Guest House, or make arrangements on your own?
Will you be driving or flying to UCLA for the symposium?
If driving, how many miles, round trip?
III. Flight Information
Please fill out this section if you will be flying to Los Angeles for the symposium. We will be making flight arrangements for you through UCLA Travel Services.
Name on Driver's License (if different from name above)
Date of Birth
Departure City/Airport
Desired Departure Date
What time of day would be most convenient for your departing flight?
Desired Return Date
What time of day would be most convenient for your returning flight?
Will you need transportation between the airport and the UCLA Guest House?

Yes No
Any other special requests we should keep in mind as we arrange your travel?
Should be Empty:

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I. Basic Participant Information