SOECP Awards and Networking Reception

Wednesday, December 8, 2021

8-9pm Central Time

Thank you for your interest in attending the first Section on Early Career Physicians Awards and Networking Reception! The purpose of this event is to showcase the incredible work of our award honorees and provide an opportunity for our members to connect with SOECP and AAP leaders.

To attend this event, please complete the registration details below. Once you submit this form, you will receive an email with a Zoom link for the event.

Registration Deadline (EXTENDED!): December 8, 2021

If you have any questions, please contact Britt Nagy.

Registration Questions

First Name *

Last Name *

Post-Nominal Letters (e.g. MD, MPH, FAAP)

Email Address *

State (abbreviation) *

AAP District (if you are unsure, please refer to the map linked here)

Preferred Pronouns

She/Her/Hers

He/Him/His

They/Them/Theirs

Prefer to self-describe Prefer to self-describe

Please indicate your relationship to the AAP Section on Early Career Physicians by selecting one of the following options: *

I am a member of the SOECP

I am a family or friend of an SOECP awards honoree

Other AAP member (please describe) Other AAP member (please describe)

AAP ID #

Do you have any questions, comments, or issues that you would like our leaders to address during this meeting? If so, please provide them in the space below. Please note that we cannot guarantee that we will have time for all items.

OPTIONAL Demographic Questions

As part of the registration process, we are collecting information to understand who are interested in our activities. This information will be reported back in summary form to the SOECP Executive Committee and AAP Leadership; no individual information will be identified.

You are not required to answer any of the questions below.

In what year were you born? Please use 4-digit format (YYYY).

What is your gender?

Female

Male

Genderqueer/gender non-conforming/non-binary

Intersex

Trans male/trans man

Trans female/trans woman

I prefer not to say

I prefer to self-describe (please use the space below) I prefer to self-describe (please use the space below)

With what racial or cultural group(s) do you identify yourself? Select all that apply.

Which of the following best represents how you think of yourself?

Bisexual

Lesbian or gay

Straight (not lesbian or gay)

Other Other

Do you have a physical, mental, or emotional disability?

No

Yes

Do you currently work part-time?

No

Yes

Please describe the community in which your primary practice/position is located.

Rural

Suburban

Urban, inner city

Urban, not inner city

Please indicate your primary employment setting. This is the setting where you spend most of your time.

Where was your medical school located?

United States

Canada

Other Other