Participant registration for the 11th Annual Summer Public Health Research Institute and Videoconference on Minority Health

9th Annual SPHRIMH	The University of North Carolina at Chapel Hill Program for Ethnicity, Culture, and Health Outcomes (ECHO)	10th Annual SPHRIMH

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

11th Annual Summer Public Health Research Institute and Videoconference on Minority Health

Register here to view the webcast or to attend at UNC-CH

Viewing location:
(required)

Internet/webcast from the Sonya Haynes Center on June 20, 2005.

(the 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 [a fictitious one if you prefer anonymity] as the first time, so that we can count viewers accurately)

University of North Carolina at Chapel Hill Sonja Haynes Stone Center (Monday, June 20) or School of Public Health (Tues-Thurs)

Satellite downlink site - please insert the Site ID:
           [please find the site you plan to attend on the list of downlink sites;
                the SiteID appears in parentheses immediately after the name of the
                the site; it is usually the 9-digit postal code]

E-mail address:

(required but can be ficticious)

Name:


First	Middle	Last

Participant code:

(Please choose a 4 digit number, e.g., last 4 digits of home or other phone number.)

Would you like to receive e-mail
announcements?

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

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:

To Register:

Click the REGISTER NOW button (below), OR
Print, complete, and fax this form to 919-966-2089, OR
Print, complete, and mail this form to:

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.

Return to the videoconference home page

Minority Health Project| Department of Epidemiology
UNC Gillings School of Global Public Health
2104D McGavran-Greenberg, CB#7435 | Chapel Hill, NC 27599-7435
Phone 919-966-7436 | Fax 919-966-2089| E-mail Minority_Health@unc.edu

Last Updated: 05/02/05 by Raj and Cal, 05/14,17/05 by Vic