2019 Roundtable Seminar for Midcareer Faculty Registration

REGISTRATION FORM
(Registration is only available for faculty members who received an invitation from Debbie Gin)

2019 Roundtable Seminar for Midcareer Faculty
April 5–6

Preconference Gathering for Racial/Ethnic Faculty
April 5, 8:15 a.m.–12:30 p.m.

Hyatt Regency Newport Beach
Newport Beach, CA

1. CONTACT INFORMATION

First Name *This question is required.

Last Name *This question is required.

Position *This question is required.

Institution *This question is required.

Institution's Mailing Address *This question is required.

Email Address (will be listed in conference booklet) *This question is required. This question requires a valid email address.

Phone, ext. (will NOT be listed in conference booklet) *This question is required.

Name as it should appear on nametag *This question is required.

Special Dietary Needs

Other Special Needs

2. The preconference gathering for racial/ethnic faculty will address issues of particular interest to racial/ethnic faculty as they emerge as leaders within their schools. Participants are, of course, expected to stay for the duration of the larger seminar that follows.
*This question is required.

3. The Educational Models Faculty Development Forum will take place on Monday, April 8. At the Forum, participants will gather insights on what’s being learned from the member schools who received faculty development grants. ATS will cover the cost of lodging Sunday and Monday evening, and meals for faculty who stay through the weekend and attend. Space for the Forum is limited.

*This question is required.