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University of Connecticut Institute for Teaching & Learning

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Lunchtime Seminar Registration Form

Complete the form below. Fields marked with an asterisk (*) are required.

If the seminar you would like to register for has "waiting list" at the end of the topic it means there are no more openings and your name will be placed on a waiting list.

Please call Stacey Valliere at (860)486-2686 or email her at to cancel your registration if you realize later that you can not participate.

* Seminar Topic: (select one)
* First Name:
* Last Name:
* Department:
* Email Address:
* Telephone:
  Vegetarian Lunch:
  Gluten Free Lunch:

If you have any questions please contact Stacey Valliere at (860)486-2686 or send her an email at