8th ANNUAL CLINICIAN EDUCATOR SHOWCASE ONLINE REGISTRATION FORM
October 10, 2019, 11:30am – 4:30pm
UPMC Western Psychiatric Hospital



GENERAL INFORMATION


First Name:
Last Name:
Degree(s):
Position Title (e.g. Assistant Professor of Psychiatry, PGYII Resident, Milieu Therapist):
Clinical Program:
Institution:
Telephone Number:
Email Address:

If you have any problems with this registration form, please contact Jeanie Knox-Houtsinger, KnoxJV@upmc.edu.