Home
Matrix mentorship
Mission
Leadership Summit
Founders
Archive
Media
Archive
Contact
Sign
Sign in
Sign Up
Menu
Home
Matrix mentorship
Mission
Leadership Summit
Founders
Archive
Media
Archive
Contact
Sign
Sign in
Sign Up
First Name
*
Date of Birth
*
Last Name
*
Gender
*
Male
Female
Other/Non-binary
Username
*
User Password
*
Confirm Password
*
How do you describe your Race and or ethnicity
*
How do you describe your Race and or ethnicity
White
Black or African-American
Asian
Middle-Eastren
Hispanic or Latino
Pacific Islander
American Indian
Other
Social Media Handles
Instagram
Linkedin
Facebook
Twitter
File Upload of Profile Photo
Drop your file here or click here to upload
You can upload up to 1 files
Number
APT Number
State / County
Phone / Mobile Number
Street Name
Town / City
Postcode / Zip
User Email
*
If MD/DO, Career stage
*
Resident
Fellow
practicing clinician
Practicing Gastroenterologist : years since fellowship
*
0-5 years
6-10 years
> 10 years
Not applicable
If Practicing clinician:
*
Private practice
Academia
Employee of a hospital system
Governmental organization
Other
Other practicing clinicians (APP, Pharma D, Psych, RD…) : years in practice
*
0-5 years
6-10 years
> 10 years
Not applicable
Degree
*
Gastroenterologist (MD/DO)
Non-GI MD/DO
Advanced Practitoner (NP,PA)
Registered Dietician
PharmD
Psychologist
Nurse
Other
Focus in GI : (check all that apply)
*
General Adult GI
Pediatric GI
IBD
Therapeutic endoscopy
Motility Disorders
Esophageal Disease
IBS
Liver disease
Pancreatobiliary disease
Obesity medicine
Basic Science and/or Translational research
Other
Get involved with the Scrubs & Heels Foundation !
1- If you are interested in joining a S & H committee and / or faculty ,
*
1- If you are interested in joining a S & H committee and / or faculty
Social media ambassador (open to residents and fellows only)
Summit ambassador (open to residents and fellows only)
Mentor for the Matrix Mentorship program (open to practicing gastroenterologists only)
Faculty at the Summit
Faculty for podcast
Writer for newsletter
Other
2- Do you give permission to Scrubs & Heels to (check all that applies)
*
email you our newsletter
share your info with colleagues for networking and professional opportunities
share your info with industry partners for networking and professional opportunities
Use pictures taken during summit or other S and H event to be shared on our social media and website
3- Do you wish to (check all that applies)
Subscribe to our newsletter
Register for the Summit Leadership 2024
Apply for the Matrix Mentorship 2024
How did you hear about the Scrubs & Heels Leadership Summit?
I previously attended
Scrubs & Heels Social media
From a GI fellow/trainee
From a GI colleague
From Healio Gastro reporting
Have you attended a Scrubs & Heels Leadership Summit previously?
It is my first time
It is my first time, but I participated in the mentorship program , or the ambassador program
Yes i have in 2022
Yes i have in 2023
5-What are your main goals for attending the Scrubs & Heels Leadership Summit
Develop your Leadership skills (communication, conflict resolution, strategic
thinking, time management, team management,managing a team, leading a team
Define your professional goals, path and style
Develop strategies for career advancement (negotiating contracts, public speaking, involvement in GI societies…)
Learn to advocate and implement steps for gender equity in GI
Develop outside the box professional initiatives
Network effectively with GI leaders and GI societies
Network effectively with your peers
Network effectively with industry partners
Acquire skills to achieve work-life integration
Acquire skills to achieve financial health
Develop a circle of mentors, sponsors, professional coach
Other
Submit
IMPORTANT NOTICE
Registration open for wait-listed :
Check your email for an invitation from:
[email protected]
CLOSE
Register for the event
CLOSE
welcome to this site
https://scrubsandheels.com/wp-admin/post.php?post=6248&action=edit
CLOSE