Account

Fill in this form to create an account with this conference.

Click here if you already have an account with this or another conference on this site.

Profile

Username*
	The username must contain only lowercase letters, numbers, and hyphens/underscores.
Password*
	The password must be at least 6 characters.
Repeat password*
Salutation
First name*
Middle name
Last name*
Initials	Joan Alice Smith = JAS
Gender	M F
Affiliation*
Signature
Email*
Twitter Username
URL
Phone
Fax
Street
City*
State/Province
Postal Code
Country*
Bio statement (E.g., department and rank)
Confirmation	Send me a confirmation email including my username and password
Create account as	Reader: Notified by email on publication of presentations. Author: Able to submit items to the conference. Reviewer: Willing to conduct peer review of submissions to the conference. Identify reviewing interests (substantive areas and research methods).

I plan to attend with*	% certainty

To help us with the planning process, please answer the following questions
	I will likely need accommodation
	I am considering to submit an abstract for a single-presenter oral presentation (enter possible title below)
	I am considering to compile/chair/participate in a panel (contact 3-4 colleagues and invite them to present with me about a certain topic)

	Draft Title for your oral single-presenter presentation or panel:

	Possible Panel Members (in addition to yourself):


If you have any specific suggestions for keynote topics or speakers (other than yourself) you want to hear from, then please enter the topic/title here, and provide name, affiliation, email address of a potential speaker (if known):

	I/we am/are interested in co-sponsoring the conference: Budget (min. $1000) $US

Please answer these questions so we get to know you better.

1. Professional setting (choose one):

2. Principal focus (check all that apply):

Teaching/Faculty responsibilities
Programming/Systems Work
Marketing/Sales
Student/Research fellow
Research
Consulting
Administration/Management
Patient Care
Public Health
Other

* Denotes required field

Medicine 2.0® is a registered trademark.