Summer Public Health Research Videoconference

2000 Summer Public Health Research Videoconference
on Minority Health

Register here to be a satellite downlink site

Note: there will be no site fee this year. The satellite coordinates will be sent to you by e-mail (or fax if you do not have e-mail) when they become available.

Organization

Organization name	Organization type

Web site (if your video facility has a web site, please provide the specific URL
so that we can include a link to it on our web site)

Postal address:	City	State	Zip code

If a different address is needed for delivery by Federal Express, UPS, etc, please provide it here

Express address:	City	State	Zip code

Viewing Location (where the program will actually be viewed at your site)

Name of facility (if different from organization name)	Number and/or name of room/auditorium

Street address of viewing location (if different from above)

Street address:	City	State	Zip code

How many people can the room accomodate?

Will members of the public be welcome to attend? Yes No

Will there be a registration fee? Yes No amount, if known:

Does your facility have the capability of disseminating the videocast to other locations and
would you like to do so? Yes No

Technical Coordinator ( the person to whom the satellite coordinates should be sent):

First name	Middle name	Last name	E-mail

Would you like to receive announcements (maximum 12 / year) about minority health / public health events available via satellite or Internet? Yes No

Telephone	Fax	Website

Site Facilitator (the person to whom we should send publicity materials, presentation materials,
bibliographies, and facilitator's handbook � this person's name and contact information will be placed
on the Videoconference web site):

First name	Middle name	Last name	E-mail

Would you like to receive announcements (maximum 12 / year) about minority health / public health events available via satellite or Internet? Yes No

Telephone	Fax	Website

How did you first learn about the 2000 video conference?

Comments

Please note:

Our ability to offer the Videoconference depends upon being able to document its value. Please help us by providing an accurate count of the number of Videoconference participants at your site. Their completed evaluation forms are similarly important.

4/8/2000, Minority_Health@unc.edu