DIGA: Affiliated DIGs
Please re-complete each year after elections:
DIGA: Dermatology Interest Group Association
DIG: Dermatology Interest Group
Medical School *
Your answer
Medical School Website
If availabe, provide your school's DIG webpage.
Your answer
City *
Your answer
State *
Your answer
DIG Primary Contact Information
Title (President, DIGA Liaison, etc) *
Your answer
Name & Year *
MS 1-4 = Medical Student 1st year, 2nd year, etc
Your answer
Name & Year *
MS 1-4 = Medical Student 1st year, 2nd year, etc
Your answer
Primary Contact person Email *
Your answer
Your DIG's email address (if applicable)
Your answer
May the primary contact's email address and medical school be listed in a private area only accessable by affiliated DIGs? This access will allow other DIG groups to contact you. *
DIG Secondary Contact Information
Title (President, DIGA Liaison, etc)
Your answer
Name & Year
MS 1-4 = Medical Student 1st year, 2nd year, etc
Your answer
Email
Your answer
DIG Advisor Contact Information
Title (Program Director, Associate Professor of Dermatology, etc.) *
Your answer
Name *
Your answer
Email *
Your answer
Thank you very much for your participation!
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