Registration Information - Leadership Summit for Advancing Women in Academic Medicine and Healthcare 2027

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* Attendee Selection

General Attendee
Sponsor - Platinum Level
Sponsor - Gold Level
Sponsor - Silver Level

Registrant Information

* First name

* Last name

* Email address

* Company

* Department

* Title

Degree

*

Are you the group lead for this sponsorship?

The group lead is the person we should contact with questions regarding your sponsorship and is responsible for registering your group. This person doesn't have to attend the summit.

This question is required.

Yes
No

If you answered NO above and are NOT the group contact, please list the group contact name and email.

*

Are you faculty or staff?

This question is required.

Faculty
Staff

How many Summits have you attended?

1-3
4-6
7-9
10
None

What brings you to the summit? Share one to three words.

*

Will you be staying for the reception?

This question is required.

Yes
No

*

How did you hear about us?

This question is required.

Email
Referred by friend/colleague
LinkedIn post
LinkedIn ad
Instagram ad
Facebook ad
Google/Search Engine
I'm previous attendee
Other

*

Will you be paying via U-M Shortcode?

This question is required.

Yes
No

*

U-M Shortcode

Work Address

Address 1

Address 2

Country/Region

USA

City

State/Province

ZIP/Postal code

Special Accommodations

Please let us know your dietary restrictions.

If you have any allergies, please complete the linked form and then upload it to complete your registration.

Upload file

Please let us know your additional accommodations.

Already registered?

Contact us: leadershipsummit@umich.edu