ASEE-NE Conference

To ensure COVID safety for everyone, all non-WPI attendees are required to attest that they

a) are fully vaccinated, or
b) have tested negative for COVID within 72 hours before the conference

You can print out and complete the attestation form and bring to registration, or complete the form when registering on-site

Last Name *

First Name *

Middle Initial *

Institute/Affiliation Name *

Title *

Mailing Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

ADA Accommodations

Check here if you require ADA Accommodations on site.

Date *

Early Bird Registration Rates (until 10/18/2021):

Faculty ($150)

Student ($50)

Regular Registration Rates (10/18/2021-10/24/2021):

Faculty ($200)

Student ($50)

Current Total:

$0.00

Registration fee includes all activities: Welcome reception, keynote and award meals, workshops and paper/poster sessions. For planning purposes, please complete below on your likelihood of attending events/sessions. This is not a commitment, only for event preparation.


	Will definitely attend	Probably will attend	Probably will not attend	Definitely will not attend
Thursday afternoon workshops	Will definitely attend	Probably will attend	Probably will not attend	Definitely will not attend
Thursday evening welcome reception	Will definitely attend	Probably will attend	Probably will not attend	Definitely will not attend
Friday morning sessions	Will definitely attend	Probably will attend	Probably will not attend	Definitely will not attend
Friday lunch keynote	Will definitely attend	Probably will attend	Probably will not attend	Definitely will not attend
Friday afternoon sessions	Will definitely attend	Probably will attend	Probably will not attend	Definitely will not attend
Friday evening keynote	Will definitely attend	Probably will attend	Probably will not attend	Definitely will not attend
Saturday morning sessions	Will definitely attend	Probably will attend	Probably will not attend	Definitely will not attend
Saturday awards lunch	Will definitely attend	Probably will attend	Probably will not attend	Definitely will not attend

Currently, what country are you physically present in? *

By providing the information requested in this form, you are consenting to WPI’s use of the provided information for the purpose for which the form is being used. See Privacy Policy Below.

Privacy Policy: https://www.wpi.edu/about/policies/privacy-policy

Refund Statement: Refunds are issued at the discretion of the Event Coordinator or Department Manager. For inquiries regarding refunds please contact the managing department of your event/program, or email bursar@wpi.edu.