Leadership Institute Registration Form

Two people from each chapter's executive board (preferably at least one being a chapter President) are highly encouraged to attend the Leadership Institute. If a chapter President cannot attend, other key exec members who plan on being highly involved in GlobeMed are recommended to attend.

Date: September 12-14

Location: Evanston, IL at Northwestern University (just north of Chicago)

Questions? Contact Ashley Hagaman (ashley@globemed.org)

Participant Information

Name (Last, First) *

University (include expected year of graduation) *

Position *

Email *

Phone *

Will you be able to attend the entire event? Your attendance is expected during the entire program for the Institute. If you cannot attend some portion of the Institute, please state which parts: *

Will you require lodging for your time here at the Institute? * yesno

Have you (or plan to) applied for a travel scholarship? * yesno

Short Answer Questions

What are the most difficult challenges you face in leading GlobeMed at your university? *

Please keep under 10 sentences.

What do you hope to gain by attending the Leadership Institute? *

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