MERC REGISTRATION $50 The registration fee covers both sessions and applies even if you are attending only one. Registration is transferable but please contact the Academy office to tell us who will be attending in your place. Fee is non-refundable. vddewitt@utmb.edu 409|747-0203

FOR QUESTIONS, CONTACT D'ANNE DEWITT AT 409|747-0203 OR vddewitt@utmb.edu

YOUR REGISTRATION CONFIRMATION WILL BE SENT UPON RECEIPT OF PAYMENT

SEATS WILL BE FILLED IN ORDER OF RECEIVED PAYMENTS

checks should be made payable to UTMB

REGISTRANT INFORMATION

LAST NAME *

FIRST NAME *

CREDENTIALS (MD, PhD, etc.) *

CONTACT PHONE *

e-mail address *

SESSION(S) (Both sessions will be held in Rebecca Sealy Hospital Room 1.124) * 🛈

Session 1 9:00 am—12:00 pm; Scholarly Writing: Publishing Medical Education Research

Session 2 1:00 pm— 4:00 pm; Formulating Research Questions and Designing Studies

PAYMENT METHOD *

CREDIT CARD

CHECK

INTERDEPARTMENTAL TRANSFER(IDT)