Mentorship Symposium Survey

Please join WIMS for our Annual Mentorship Symposium.
The event will be held Tuesday, February 19, 2013 at 6:00 pm in the Chili's Care Center on the St. Jude campus.
The cost for attendance is $10 for WIMS Members and $15 for non-members.

1. First Name

First Name

2. Last Name

Last Name

3. Faculty or Student

Faculty or Student Student

Faculty

4. What college are you in?

What college are you in? Medicine

Dentistry

Nursing

Graduate Health Sciences

Pharmacy

Allied Health

St. Jude

Local/Community Professional

5. Are you a WIMS member?

Are you a WIMS member? Yes

6. Meal Option

Meal Option Regular

Vegetarian

7. How are you paying? (Payment due by February 12th)

How are you paying? (Payment due by February 12th) Check/Cash

WIMS Venmo Account

8. Email Address

Email Address

Ticket prices are:
$10 for WIMS Members
$15 for Non-members

To pay by check or cash, please send to:

WIMS
C/O Rachel Scheib
262 Danny Thomas Place
MS 313
Memphis,TN 38105-2794

Make checks payable to Women in Medicine and Science

For Venmo:
If you are not already a member, the website to sign up is https://venmo.com/
Once signed up, search for the email address wims.exec@gmail.com; our official name is WIMS UTHSC.

Please note that your spot is not officially reserved until we have received payment.

Thank you.