2012 Faculty Development Colloquium

June 6, 2012

Registration Form

Personal Details
* Name
  Degree
* TItle
* Department
  Institution
  Box # or Address
  City / State / Zipcode
  Office Phone
* Email
  Birthdate (MM/DD)
* Luncheon

  Food Allergies :
Poster Submission    * I want to display a poster :

Workshop Selection Workshop placement will be made on a first-come, first-served basis.

Click here for a listing of offered workshops
Morning Session 10:00-12:00 (Please rank your top 3 choices)
We will do our best to place you in your first choice.
#1
#2
#3

Afternoon Session 2:15-4:15 (Please rank your top 3 choices)
We will do our best to place you in your first choice.
#1
#2
#3

You will receive information via email by June 4th with your workshop assignments.

Please submit registration by May 27th

There is no charge for University of Rochester faculty, residents & students.

Pricing:

* Institutional Group Rate: $350 (admits three Non-UR faculty and three students and/or residents)
* Individual faculty: $150
* Student/Resident: $25

Please make checks payable to:
University of Rochester School of Medicine & Dentistry

And mail to:

University of Rochester School of Medicine & Dentistry
Office of the Associate Dean Faculty Development-Medical Education
601 Elmwood Avenue, Box 706
Rochester, NY 14642


Breakfast and lunch will be provided for all registrants.

   

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