Committee on Medical Students and Residents (MSR) _Special Interest Group Sign-up

Demographic Information

Please complete the questions below.

First Name

Last Name

Institution

State/ Province

Country

List up to three area(s) of interest specific to child mental health:

Medical Student

General Psychiatry Resident

Child and Adolescent Psychiatry Fellow

Combined Child/Adolescent and Adult Psychiatry Residency

Triple Board Resident

Post Pediatric Resident

Other (please specify)

Yes

Female

Male

Non-binary