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Digital Medicine and Digital Therapy Salon
Salon Request Form
Please take a moment and tell us about yourself by filling out the survey below.
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1.
Your Information
(Required.)
First Name
Last Name
Title
Company
Email
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2.
Harvard School (Choose all that apply)
(Required.)
Harvard College
Harvard Business School
Harvard T.H. Chan School of Public Health
Harvard Dental School
Harvard School of Design
Harvard Divinity School
Harvard Graduate School of Arts and Science
Harvard Graduate School of Education
Harvard John A. Paulson School of Engineering and Applied Science
Harvard Extension School
Harvard Kennedy School
Harvard Law School
Harvard Medical School
Executive Ed Program, Fellows Program
Current Harvard Student
Harvard Professor/Staff
Radcliffe/ Radcliffe Institute
Harvard Faculty, Fellow, Staff
Not a Harvard Alumnus/ae
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3.
Please paste the URL of your LinkedIn profile below.
(Required.)
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4.
Please enter a short bio (tweet-length!) for yourself below.
(Required.)
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5.
What is/are your goal(s) for joining this salon?
(Required.)
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6.
I am a....
(Required.)
Founder
C-Suite
Entrepreneur
Investor
Professional Services (Lawyer, Accountant, Doctor, Engineer...)
Academic
Other (please specify)
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7.
Are you currently a paid member of HAE?
(Required.)
Yes
No
