Exit Event Registration Form Healthcare Workforce Summit Registration Form Question Title * 1. Name Question Title * 2. Email Question Title * 3. Phone (optional) Question Title * 4. Company/Organization Question Title * 5. Do you plan to attend in-person or virtually? In-person Virtually, as an individual Virtually, with a regional team of partners Question Title * 6. Individual Virtual Attendees: Please share what city you are joining from. Question Title * 7. Individual Virtual Attendees: Please indicate if you would like support connecting with a regional group. Yes, help connect me with partners that are virtually attending the Healthcare Summit in a shared space No Question Title * 8. Group Virtual Attendees: Please share what city you will be joining from with partners. Question Title * 9. Please indicate if your virtual group needs support identifying a meeting space. Yes, we need support identifying a meeting space. No, we have identified a meeting space. Question Title * 10. Do you follow any of the these dietary restrictions? Vegan Vegetarian I do not follow these dietary restrictions Other (please specify) Question Title * 11. What do you hope to accomplish by attending this event? Question Title * 12. What do you wish to gain (new connections, resources, data) from this event? Done