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REGISTRATION
Please complete the following registration for the
"Meet the Mentor"
brown-bag session with
Tracy Weitz
on
Tuesday, November 13, 2012 from 12 - 1 p.m.
, Parnassus, Room S-175.
1
. First Name:
First Name:
2
. Last Name:
Last Name:
3
. Email Address:
Email Address:
4
. School:
School:
School of Dentistry
School of Medicine
School of Nursing
School of Pharmacy
5
. Department/Division:
Department/Division:
6
. Academic Position:
Academic Position:
Instructor
Assistant Professor
Associate Professor
Professor
Other (please specify)
7
. How did you hear about this event? Check all that apply.
How did you hear about this event? Check all that apply.
Email
Academic Affairs website
Faculty Mentoring Program website
Poster
Word of mouth
Other (please specify):
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