Clinical Faculty Academy- Participant Registration Question Title * 1. Session August 1-2, 2024 in Columbia, SC (Midlands Technical College- Airport Campus) Question Title * 2. Name Question Title * 3. Email Question Title * 4. Cell Phone (only used to contact in case of emergency) Question Title * 5. Institution or Hospital Affiliation Question Title * 6. Job Title Question Title * 7. Please select your highest level of education. Associate Degree Baccalaureate Degree Master's Degree Doctorate Other (please specify) Question Title * 8. Do you have any previous teaching experience? Yes No If yes, please explain Question Title * 9. How did you hear about the Clinical Faculty Academy? Question Title * 10. Commitment Statement: I understand that there is no fee to participate in the Clinical Faculty Academy. However, I am committing to attendance for both days of the training. Yes No Question Title * 11. Lunch will be provided by a sponsor both training days. If you have any food allergies or dietetic restrictions, please be prepared to bring your own lunch. I understand lunch will be provided and should bring my own due to food allergies or dietetic restrictions. I have no food allergies or dietetic restrictions. Done