MIEC24 Session Chair Information Submission

Name(Required)

Prefix First Middle Last Suffix

Nickname

First

Do you have a nickname you would prefer to be printed in the place of your legal first name? If so, please enter it here. Leave blank if not applicable.

Credentials

i.e. PhD, MPH, MD, etc.

Institution(Required)

College

Leave blank if not applicable.

School

Leave blank if not applicable.

Department

Leave blank if not applicable.

Program or Office

Leave blank if not applicable.

Classification(Required)

Associate Professor

Assistant Professor

Professor

Associate Dean

Assistant Dean

Dean

Other

Please select as many as apply.

Other Classification(Required)

Institutional Email(Required)

Office Phone(Required)

Professional Headshot(Required)

Accepted file types: jpg, png, jpeg, Max. file size: 300 MB.

Please upload your professional headshot for printing in the conference journal. If you do not have a professional headshot, please upload a high-resolution, self-made headshot.

CAPTCHA

This field is for validation purposes and should be left unchanged.