Hacking Dermatology Participant Application
If you are interested in being considered to be a participant at Hacking Dermatology on September 13-15, 2019, please complete this application. Applications will be considered on a rolling basis and you will be notified within 2 weeks of your application being submitted. Participants will join teams and compete in the hackathon activities.

If you are interested in being a mentor, who shares expertise and guidance with multiple teams, please fill out the mentor application (https://forms.gle/1Vo5Z2G72AxsDNV56).
Email address *
First Name *
Your answer
Last Name *
Your answer
Please list your preferred credentials:
Your answer
What is your age range? *
Please tell us which city, state, and country you will be coming from? *
Your answer
Which of the following best describes you? *
What is your school/company affiliation? *
Your answer
What is your current title? *
Your answer
What best describes your background? Examples: Physician/Dermatology, Scientist/Data Scientist, or Designer/Industrial Design *
Required
Can you commit to attending all three days on September 13-15, 2019? *
What is your experience in innovation / hackathons / healthcare / dermatology (if any) and what are some relevant skill sets/prior experience? *
Your answer
Do you have any preliminary ideas you’d like to work on during the hackathon? This is NOT a prerequisite. * *
Please tell us the title of your idea/project, the general idea, goals, and data sets/resources needed to work on project.
Your answer
How did you hear about this event? *
Required
Comments / Questions / Concerns?
Your answer
When you attend the hackathon and/other other related events, you will enter an area where photography, audio, and video recording may be taken and where members of the media may be present to cover the event. By attending this event, you consent to photography, audio, and video recording and its release, publication or reproduction to be used in the future. Do you acknowledge this? *
A copy of your responses will be emailed to the address you provided.
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