Registration

Registration Form

I do hereby give Jackson State University the right to use my name, picture, portrait, video, or photograph in all forms and media and in all manners, including composite or other representations, for use in Jackson State University’s publications, advertisements, and electronic media:*

Participant’s Information

Name:*
Member Type:*

University Affiliation Information

Affiliation:*
Department: (optional)
Address:*

Contact Information

Phone (optional):
-
Email Address:*

Abstract and Picture Upload

Type of Registration:*
The Abstract`s Title:*
Upload Your Abstract: (doc, docx)*
Upload Your Photo: (jpg, jpeg, png, gif, tif)*

Method of Payment

Select:*
Reference Number:*

Submit Registration Form

Security code:

JAN-Panorama

JAN-Panorama