2019 LGBT Health Workforce Conference Registration

Registration Type*
- Undergraduate Student Conference Registration (copy of valid ID required) $50
- Graduate Student Conference Registration (copy of valid ID required) $125
- Graduate Student 7th Anniversary Registration (copy of valid ID required) $265
- Resident/Fellow Conference Registration (copy of valid ID required) $150
- Resident/Fellow 7th Anniversary Registration (copy of valid ID required) $290
- Health Professional Conference Registration (Excluding MD,DO,DDS; copy of valid ID required) $220
- Health Professional 7th Anniversary Registration (excluding Dentists or MD/DO; copy of valid ID required) $360
- Dentist or Physician Conference Registration $285
- Dentist or Physician 7th Anniversary Registration $425
- Student, Resident or Fellow (copy of valid ID required) May 2-3 Writing Seminar Registration $100
- Health Professional May 2-3 Writing Seminar Registration $150
- Guest Ticket for Awards Celebration Dinner $150
Scan of ID/Letter
If necessary, please upload a scan of your valid ID or another official letter which designates your status.
Accepted file types: pdf.
Conference registration covered by my sponsoring institution?
Click on this option ONLY if your institution is listed below. Sponsorship DOES NOT not cover payment for the May 3 Awards Dinner
- Yes
Sponsoring Institution
Institutional sponsorship covers conference events. It DOES NOT not include the Friday evening dinner
Name*
First Last
Email*
BNGAP username*
If you have not yet registered for BNGAP.org, please write "Not registered"
Position/Title*
Degree*
Street Address*
City*
State*
Zip Code*
Country
Phone*
Race/Ethnicity*
Select all that apply
- Asian
- Black/African-American
- Hispanic/Latino
- Native American/Alaskan Native
- White
- Prefer not to answer
- Other
Specify if Other
Gender Identity*
Specify if Other
Sexual Orientation*
Specify if Other
Dietary Preferences*
Specify if Other
Food Allergy?
I plan to attend conference events on the following dates:*
Check all that apply.
- Thursday, May 2 Writing Seminar Introduction
- Thursday, May 2 NYC Historical Walking Tour
- Friday, May 3 LGBT Conference Presentations
- Friday, May 3 Writing Seminar Activities
- Friday, May 3 Awards Dinner
- Saturday, May 4 LGBT Conference Presentations
- Saturday, May 4 Evening Celebration
- Saturday, Ma 4 Evening Celebration
Your total registration fee
Please press submit to continue to Paypal to complete your registration.
$0.00
Comments
This field is for validation purposes and should be left unchanged.