DIGA 2022 - 2023 New Chapter Form
Hello! Thank you for your interest in being an affiliated DIG with DIGA!

By filling out this form your school's DIG leadership will be provided with updates on opportunities in dermatology and be included in our DIG network for inter- and intra-regional events.

Our 2022 - 2023 Regional Directors are listed below. If you do not receive an introductory email from them within 2 weeks after filling this form, please follow-up with them.
Western: Martha Oberg - martha.oberg@wsu.edu 
Midwestern: Christi Druskovich - druskov4@msu.edu
Southern: Max Green - mgreen15@tulane.edu
Northeastern: Madi Kist - mkist@pennstatehealth.psu.edu
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Email *
Medical School *
City *
State *
DIG Region (see photo) *
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Do you have a home dermatology program? *
Medical School Website (if available, provide your school's DIG webpage)
We will link this on our website.
DIG Chapter Email (if applicable)
DIG Social Media Handles (twitter, IG, FB):
DIG Primary Contact Name (First & Last) *
DIG Primary Contact Title (President, DIGA Liaison, etc.) *
DIG Primary Contact Year *
DIG Primary Contact Email *
May the primary contact's email address and medical school be listed on our website? This will allow other school's DIGs or students near you without a DIG to contact you. *
DIG Secondary Contact Name (First & Last)
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DIG Secondary Contact Title (President, DIGA Liaison, etc.)
DIG Secondary Contact Year
Clear selection
DIG Secondary Contact Email
DIG Advisor Name (First & Last)
DIG Advisor Title
(Program Director, Associate Professor of Dermatology etc.)
DIG Advisor Email
Please only share if your DIG advisor would be comfortable in sharing their email - it will only be listed on our internal documentation.
A copy of your responses will be emailed to the address you provided.
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