LGBT Symposium Registration

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LGBTPM+ Symposium Registration Form

Toward Higher Standards: Issues Regarding Sexual Orientation in the Academic Health Care Environment
April 21, 8:00-1:00
BRB, please see below for specific room locations

Please register by April 12, if possible. If you wish to change your registration information later, just resubmit the form and check the box at the bottom. All registration information will be kept confidential.

* indicates required fields

*First Name:
Middle Name:
*Last Name:

*E-mail:

*Role/Rank:
Track:
Department:
Administrative title:
Years at Penn:

*Please indicate which parts of the event you will attend:
	Breakfast and networking (8:00-9:30, BRB 14th floor lobby)
	Workshop (9:30-10:45) three run concurrently, please choose one:
	Plenary talk by A. Robinson Williams: My Right Self: Transgender Considerations (11:00-12:00, BRB Auditorium)
	Networking (12:00-1:00, BRB 14th floor lobby)

Please check this box if you submitted a registration before: