User registration - scrubsandheels.com

First Name *

Date of Birth *

Last Name *

Gender *

Number

APT Number

State / County

Phone / Mobile Number

Street Name

Town / City

Postcode / Zip

User Email *

Twitter

Facebook

How do you describe your Race and or ethnicity *

If MD/DO, Career stage *

Other practicing clinicians (APP, Pharma D, Psych, RD…) : years in practice *

Focus in GI : (check all that apply) *

Instagram

Degree *

Practicing Gastroenterologist : years since fellowship *

If Practicing clinician: *

Username *

Confirm Password *

User Password *

1- If you are you interested in joining a S & H committee and / or faculty , *

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)

How did you hear about the Scrubs & Heels Leadership Summit

Have you attended a Scrubs & Heels Leadership Summit previously?

What are your main goals for attending the Scrubs & Heels Leadership Summit