Experiential Learning Summit 2026

Contact Information

First Name

Last Name

Company/School

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Phone Number:

Professional and Affiliation Information

Please describe

Please describe your affiliation with the University of Rochester School of Nursing

Please describe

Please let us know if you are from an Apple Distinguished School:

I am from an Apple Distinguished School!

Conference Information

Help us get your name , title, and credentials right! Please fill in your information exactly how you would like it to appear on your nametag!

Preferred name and credentials as you would like them to appear on your nametag

Job title as you would like it to appear on your nametag

In an effort to provide safe food options for our guests, we ask that you please indicate any dietary restrictions and/or preferences within your party.

Do you have any food allergies? Please select all that apply.

Please Describe

Do you have any dietary preferences? Please select all that apply.

Please describe:

Let us know how you heard about this event:

Please Describe:

Payment Information

Please select the checkbox if you are an employee, alumnus/a, or student at the University of Rochester

I am an employee, alumnus/a, or student at the University of Rochester

Please let us know if you are a primary presenter at the Summit:

I will be a primary presenter at the Summit

Please let us know if you are a co-presenter at the Summit:

I will be a co-presenter at the Summit

What is the title of your presentation?

Enter payment

Amount Due
Loading...

Amount Due

Loading...