Register for the Internet broadcast of the 14th Annual Summer Public Health Research Videoconference on Minority Health

	The University of North Carolina at Chapel Hill Program for Ethnicity, Culture, and Health Outcomes (ECHO)

	Your guide to minority health-related activities at UNC-CH and elsewhere

14th Annual Summer Public Health Research
Institute and Videoconference on Minority Health

Internet Broadcast Registration Form

Please register here to view the webcast (info)

(The following requested information helps us to evaluate the event; if you have already completed the form once and are returning to view the webcast, please fill in the same e-mail address as the first time, so that we can count viewers accurately) [the email address is the only required field for webcast viewers; if you prefer anonymity, please enter anything in this field, without a "@"]

E-mail address:

(required - but can be fictitious)

Would you like to receive e-mail
announcements?

Yes (maximum 12/year; about minority health / public health events)
No

Name:


First	Middle	Last

Will you be hosting the webcast for a group of people (e.g., using a computer projector)?

(Please explain briefly here or in the comment box below.)
About how many people do you expect, including yourself?

Country:

USA

Canada

Mexico

Other :

State:

State(if USA):

State(if not US):

Postal code:

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

Job title/ position:

Occupation:

Comments:

If applicable, may we quote you (anonymously or with whatever identification you included with your comment) on our website?
Yes No

Minority Health Project
Department of Epidemiology, School of Public Health
University of North Carolina at Chapel Hill
McGavran-Greenberg, CB# 7435
Chapel Hill, NC 27599-7435

Privacy Notice: We at the Minority Health Project respect your privacy. You will never receive any unwanted email or postal mail as a result of the information you have given to us. Minority Health Project does not sell, rent or give any identifiable personal information to any third party.

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 send email to Minority_Health@unc.edu. Please use an informative subject line, since we receive a great deal of spam.

Return to the Videoconference home page

Last updated: 04/14/2007, 4/3/2008 by Vic