Fireside Chat Registration-Say My Name
*
1.
I will attend the DEI Fireside Chat on February 22 at 5:30 p.m.
(Required.)
Yes
*
2.
Name (First and Last)
(Required.)
*
3.
Email Address
(Required.)
*
4.
I am
(Required.)
Faculty
Trainee
Clinical Staff
Administrative Staff
Other (please specify)
*
5.
Primary Campus Assignment (where your office is when not working remotely) or Current Rotation Location
(Required.)
Emory University Hospital/Emory Clinic/Winship
Emory University Hospital Midtown/MOT
Emory Johns Creek Hospital
Emory Decatur Hospital/Hillandale
Grady Hospital
Emory Executive Park (all facilities)
EUOSH
Children's (all locations)
Other (please specify)
