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* 1. I will attend the DEI Fireside Chat on Tuesday, May 31 from 7:30 to 8:30 a.m.

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* 2. Name (First and Last)

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* 3. Email Address (must be associated with a healthcare-related or academic institution)

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* 4. I am

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* 5. Employer/School

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* 6. If your employer is Emory, what is your primary Emory location (where your office is when not working remotely) or Current Rotation Location? Skip if you don't work for Emory or its network affiliates.

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* 7. How did you hear about this event?

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* 8. What do you hope to gain from attending this event?

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