GWIMS Symposium Registration
Please complete this form by Friday, November 17 to register for the GWIMS event on Tuesday, November 28.  Email gwims@med.wisc.edu any questions, and visit https://go.wisc.edu/gwimssymposium for more information. 
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First name *
Last name *
Credentials
MD, PhD, etc.
Pronouns
Department *
Wisc.edu email address *
This is where we'll send any event information or reminders.
Do you plan to attend? *
Required
I plan to stay for the reception from 4:15 - 5 p.m. and you should count me in for food.  *
We're working to curate delightful event experiences with plenty of refreshments, while being mindful of food waste and sustainability needs, so your separate RSVP is requested for the reception. 
I have the following dietary restrictions:
I am..  *
Required
Please submit any questions for the panel below.
We’ll be having a panel discussion covering a range of topics relevant to supporting women in medicine & science. Please submit any advance questions for the panel you may have, acknowledging we may not have time for all questions to be asked.
Do you need any of the following accommodations:
Submit
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