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Office of Faculty Development

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Workshops, Conferences and Grand Rounds • Workshop Calendar •
Workshop Registration Form • Evaluation Data

WORKSHOP REGISTRATION FORM

Please complete and submit the form below to register for a workshop offered by the Office of Faculty Development. Once you click Submit, you will receive an e-mail from us to confirm your participation.
Workshop Name:
Workshop Date:
First Name:
Last Name:
Degree:
Academic Rank:
Department:
Office Address:
E-mail:
Daytime Phone:
Comments:
Gender:
	Provision of this information is voluntary. It will be used for non-discriminatory purposes such as determining how we might effectively meet the diverse needs of faculty.
Specify Other:
	Please specify your degree if not found on the selection list above.
ECU Health Sciences Affiliation:
Specify Other:
	Please specify your affiliation if not found on the selection list above.
Specify Other:
	Please specify your department if not found on the selection list above.
Specify Other:
	Please specify your academic rank if not found on the selection list above.