2012 FPR-UCLA Culture, Mind, and Brain: Emerging Concepts, Methods, Applications Conference: Required Pre-registration Information

SOLD OUT. Waiting List is now in effect. You may only register by fax, mail, or in person at the UCLA Central Ticket Office windows. You will only be billed if you get a seat.

The Pre-Registration Form in Word and PDF.

You must pay your registration fee AND submit your completed pre-registration form to secure your seat at the conference. Seats are only available on a first come, first served basis. Submitting your pre-registration form alone is NOT sufficient to secure your seat.

  • Type of Attendee: General Public University of California Faculty or Staff Graduate Student Undergraduate Student
  • Title: Dr. Miss Mr. Mrs. Ms.
  • First Name:
  • Middle Name:
  • Last Name:
  • Name of the person whose credit card or check used for registration payment:
  • Educational Degree(s) Attained (please specify)
  • Mailing Address:
    Street Address:
  • City: State:
  • Zip Code:
  • Country:
  • E-mail Address:
  • Phone Number:
  • Fax Number:
  • Institutional Affiliation, Current Employer, or School:
  • Current position / occupation (please specify)
  • Primary area of specialization (check all that apply)
    Anthropology History Neuroscience Philosophy Psychiatry Psychology
    Public Health Other areas - please specify
  • Secondary area of specialization (e.g., psychological anthropology; history of science; cellular biology; philosophy of mind; developmental psychology; clinical social work) - please specify
  • Other areas of interest

The 2012 Conference