PREFAC Seminar Academic Medicine Career Development

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Registration Type*

COLLEGE STUDENT/POST-BACC
MEDICAL STUDENT
PHD STUDENT
RESIDENT
FELLOW
OTHER
SPEAKER/FACILITATOR

If you marked 'Other', please elaborate

Please describe 'Other'? (e.g. dental student, nursing student, staff, faculty member, etc.)

For learners, what is your year of training (select one)?

Please indicate your year of training. This is for any active college student, medical student, resident, fellow or graduate student.

If participant, how INTERESTED are you in a career in academic medicine?*

Very interested
Interested
Neither interested nor disinterested
Disinterested
Very disinterested
N/A - speaker

Location (select one):*

Hackensack Meridian School of Medicine, NJ, Dec 6 (H)
New York Medical College, NY, Dec 11 (H)
MSPA - BNGAP Seminar, (Virtual) February 22, 2026
Dr. Kiran C. Patel College of Allopathic Medicine, FL, March 7 (In-Person)
Oklahoma University College of Medicine, OK, March 28 (H)
Geisinger College of Health Sciences, Sat, March 28
University of California San Francisco, San Francisco, April 11 (H)
Univ. of Colorado Anschutz School of Medicine, CO, April 17 (H)
Univ of New Mexico, Health Sciences Center & SOM, NM, April 18 (H)

For medical students, residents and fellows: Would you like to meet with a residency recruiter or faculty recruiter to discuss opportunities at their institution?

Yes
No

If yes, which specialty are you considering or currently practicing?

Name*

First Last

Institutional Email*

Personal Email*

BNGAP username*

If you have not yet registered for BNGAP.org, please write "Not registered"

Position/Title*

Institution*

Permanent Street Address*

City*

State*

Zip Code*

Country

Phone*

Dietary restrictions?*

Race/Ethnicity*

Asian
Black/African-American
Hispanic/Latino
Native American/Alaskan Native
White
Prefer not to answer
Other

Specify if Other

Birth sex*

Specify if Other

Sexual Orientation*

Specify if Other

Gender Identity*

Specify if Other

Will you be attending in person or virtually? (Not applicable for Envisions Conference)*

We are working with host institution leaders to try and identify trainees who are willing to host out-of-town participants conference participants.

If applicable (your institution is hosting), are you willing to host an out-of-town participant?

Yes
No
Not Applicable

Criteria for hosting

Do you have any specific criteria for hosting (male or female, etc)?

If applicable (you are coming from another institution), would you like to receive information on staying with a host trainee or faculty member?

Yes
No
Not Applicable

Would you be willing and interested to carpool to the sites with other participants?

Yes
No
Not Applicable

Any other comments or questions?

Your total registration fee

Please press submit to continue to Paypal to complete your registration.

$0.00

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PREFAC Seminar Academic Medicine Career Development

PREFAC Seminar Academic Medicine Career Development Registration