2002 Summer Public Health Research Institute and Videoconference on Minority Health

Preregistration for participants at UNC-CH

Find a Videoconference site in your state

The Videoconference will be produced in the Mayes Telecommunications Center (room 231 Rosenau Hall) and will be carried via closed-circuit video to the Ibrahim Seminar Room (1301 McGavran-Greenberg Hall). Participants in the studio (the Mayes Center) will be able to ask questions in person, though when there are questions or comments from remote sites we will give them priority. Participants viewing on closed-circuit video will be able to ask questions/make comments by telephone, fax, and e-mail (cell phone might be best!).

Since the studio audience is limited by the size of the Mayes Center and since it will be on camera, the studio audience will be selected from among registered participants in order to achieve a diversity of backgrounds, professions, experience, etc. Also, studio participants are requested to be in their seats by 1:15pm, stay for the entire session, and not bring food or drink into the facility. Since the other room (1301 McGavran-Greenberg Hall) is larger and more accessible, participants can enter and exit more freely.

To preregister, please provide the information below and then click the REGISTER NOW button.
Items marked with an * are required.

*Name

       
      *First                 Middle                   *Last
*Participant Code
(Please use a total of 4 digits, e.g., last 4 digits of home or other phone number.)

Agency

Type of Agency
Local Health Dept. Other Government/Municipal Agency
Managed Care Hospital/Medical Practice/Nursing Home
Educational/Research/AHEC Community/Consumer/Advocacy/
Philanthropic
Business/Commercial Professional Society

*Address (line 1)

Address (line 2)

*City

 *State  *Zip

County

*E-mail Address

Job Title/Position

*Occupation

*Daytime Phone

Area code + number

Fax

Area code + number

Evening phone

Area code + number
Are you a student, faculty member, or staff member at UNC-CH? No  Yes, department: 
Are you a graduate of the UNC-CH School of Public Health? No  Yes, department: 
_____________________________
On which days do you plan to attend?     Monday? No  Yes
Tuesday? No  Yes
Wednesday? No  Yes
Thursday? No  Yes
Friday? No  Yes
Would you like to be in the studio audience? (space permitting) No  Yes
Do you wish to receive CE credit for attending these sessions (requires a modest fee and approval of our application)? No  Yes 
_____________________________
Please briefly indicate your reasons for wanting to attend the Videoconference and/or be part of the studio audience:

There is no registration fee

To Register:

  • Click the REGISTER NOW button (see below), OR

  • Phone the registration information to at 919-843-6934, OR

  • E-mail the registration information to Minority_Health@unc.edu, OR

  • Print this form to and fax it to 919-966-0458, OR

  • Mail your completed registration form to:

    Minority Health Project
    Department of Maternal and Child Health
    UNC-CH School of Public Health
    CB# 7445, Rosenau
    Chapel Hill, NC 27599-7445

If you require any of the auxiliary aids or services identified in the American with Disabilities Act in order to participate in this program, please call at 919-843-6758.

You will receive email or written confirmation of your registration. If you have not received a confirmation within one week of submission, please call 919-843-6934 to check on the status of your registration.

Admission to School of Public Health programs is without regard to race, sex, national origin, color, religion, handicap, age or veteran's status.

If you have any questions about this conference or registration, please call 919-843-6934 or send email to Minority_Health@unc.edu.


         

04/05/2002raj