Targeted Protein Degradation and Induced ProximityRegistration Form

Targeted Protein Degradation and Induced Proximity

Registration Form

Welcome Dinner: Sept 9, 2025

Symposium: Sept 10-11, 2025

Symposium Website

Contact information

First / Middle / Last Name*

As it appears on your Legal ID (will be used for travel reservations)

First and Last Name

As it will appear on your nametag

List credential(s)

Only include if you want it listed on your nametag

Title

Lab Name/Dept

Company or University*

Email address*

NPI Number (applies to Healthcare Providers)

At Promega Corporation, we prioritize integrity and transparency, adhering to international and local laws, industry ethics codes, and organizational policies that regulate our interactions, particularly involving gifts, travel, and other benefits with healthcare professionals, academics, and government officials. To ensure we meet these standards, we kindly ask you to inform your Promega contact of any specific reporting obligations or restrictions you may have regarding receiving such benefits. Your cooperation is crucial for our mutual compliance and ethical engagement.

NPI License # (applies to Healthcare Providers)

State of NPI Licensing (if applicable)

Do you approve of sharing your email address with other symposium participants?*

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Mobile number*

Please list a contact in case of an emergency.*

Emergency contact phone number.*

Main Session Presenter Feedback

Have you been contacted by the Symposium organizer and identified as a main session presenter?*

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You will have a walk on song as you approach the podium. What is your favorite song(s)? Please list artist and title of song(s).*

What kind of energy do you want your walk-up song to convey? For instance, do you prefer an elegant, energetic, mysterious, reflective, rebellious vibe, or something else entirely?*

Poster Request

Are you interested in presenting a poster? If yes, please state topic.

Travel and Meal Requirements

Will Promega be sponsoring your travels?*

Please review Promega Sponsorship FAQ/Guidelines

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Do you require hotel reservations?*

The symposium hotel block is at Embassy Suites by Hilton Madison Downtown 231 S. Pinckney Street, Madison, Wisconsin, 53703, USA, Opens new tab

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Do you need flight reservations?*

Default arrival/departure Sept 9-11, 2025. If you have special requests, please state in comments section. Our travel department will reach out to you in May/June to book flights. The hotel reservations will be based on flight dates.

Yes

Date of Birth

State or Country

Seat preference

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Outbound flight (3 letter airport code - ie MSN)

Return flight (3 letter airport code - ie MSN)

TSA PreCheck KTN 9-digit # (leave blank if no)

If driving, do you need a hotel room reservation?

The symposium hotel block is at Embassy Suites by Hilton Madison Downtown 231 S. Pinckney Street, Madison, Wisconsin, 53703, USA

Select or enter value

Hotel check-in date

Hotel check-out date

If driving, list city & state you will depart from

List dietary restrictions and/or allergies

Comments

List any travel preferences or special requirements

Guidelines

Do you approve of the following:

I agree to receive e-mails about topics such as promotions, seminars, surveys, trainings, products, and technologies.

Yes

Do you agree to the following:

I have read and agree to the Promega Guidelines for Processing Personal Information.

Yes

Do you approve:

Promega will be documenting this event in photography and video formats. As an attendee, you may appear in this media. The event media may be used on our website, social media pages, or other marketing collateral.

Yes

COVID-19 policy, Promega follows the CDC guidelines.

For questions or concerns, please email: symposium@promega.com

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