24th Annual Minority Health Conference
Social Determinants of Health: Assembling Pieces of the Puzzle

Register here to be a satellite downlink site

Note: your on-line registration indicates your acceptance of the Site Agreement. The Site Agreement covers, among other matters, permitted use of recordings from this broadcast. The UNC School of Public Health does not charge a site fee for this program.

Organization (* = required field)

   *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
-

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

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

   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

Site Facilitator (the person who is responsible for coordinating this event at your site
- this person's name and contact information will be placed on our web site
unless you request otherwise (* = required field):

  *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 broadcast of the 24th Annual Minority Health Conference?
   
    Comments   

    Do you agree to the terms of the Site Agreement?      Yes  No

Technical Coordinator ( the person responsible for technical matters at your 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

Please note:  As a grant-supported activity our ability to offer these programs depends upon being able to document their value. Please help us by providing an accurate count of the number of Conference participants at your site and completing the site evaluation we will send following the Conference.


Back to top  Satellite broadcast information  Webcast information  24th Annual Minority Health Conference Information


11/13/01raj, 02/02/02rajMinority_Health@unc.edu