Providers Information Page-TAD 2009
Exit this survey 

1. TAD 2009

 
Registration is closed.

We are looking for health providers (doctors, nurses, dentists, social workers, health educators, etc) to volunteer their time, at least one hour from the list of our partnering shops/salons, to educate community members about your area of expertise.

Registration will be closed at noon on September 15th.

Please fill out the following information:

1. Please fill out the following information:

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2. Service You Will Provide on Sept 17

Please pick which shop/salon you would like to attend. You will receive an email confirmation of the shop/salon and time you choose. For shop/salon locations please copy and paste in your browser http://www.cmh.pitt.edu/healthprofessional.asp
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3. Shop/salon Choice #1. Please choose your FIRST choice shop/salon.

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4. Shop/salon Choice #2. Please choose your SECOND choice shop/salon.

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5. Time Choices. Please enter the time you will be available for 1ST CHOICE & 2ND CHOICE shops/salons (ex. 10am-2pm)

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6. Orientation Attendance. Please select the orientation you will attend:

7. Comments

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8. By checking this box you agree to not hold the University of Pittsburgh or any of its affiliates responsible for any accidents or incidents, whether professional or personal while voluntarily participating in the Center for Minority Health’s “Take a Health Professional to the People” day event.

If you have any questions please call 412-624-9472.