MIRMSS 2018

Loews Chicago Downtown
Chicago, Illinois
Saturday, May 19, 2018


PLEASE NOTE THAT NO CONFIRMATION EMAIL IS GENERATED UPON SUBMITTING THIS FORM.
In the coming weeks you will receive a confirmation email with a link to a pre-symposium survey. If you have any questions, please contact Dr. Navuluri (IR@uchicago.edu)


***A photographer may take photos at MIRMSS of attendees who are participating in sessions and/or activities. Please be aware that these photos are for MIRMSS use only and may appear in symposia brochures, programs, publications, the MIRMSS website, social media or other SIR RFS section materials. Your attendance at the symposium constitutes your permission and consent for this photography.

Email address *
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
City *
Your answer
State *
Your answer
Medical School *
Your answer
Gender *
Level of Education *
Which symposium will you be attending? *
The General Symposium is recommended for 1st and 2nd year medical students, as well as 3rd year students who have not previously attended MIRMSS. The Advanced Symposium is recommended to 3rd or 4th year medical students who are planning on pursuing an IR residency.
Will you be attending the "Women in IR" luncheon? *
Will you be attending the networking event? *
5:00 pm - 6:30 pm
Lunch preference *
Did you attend MIRMSS last year? *
How did you hear about this event? *
What specialties are you considering? (optional)
Check all that apply
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms