Montana Faculty Development Conference

Dates: Friday, April 12 - Sunday, April 14, 2024
Registration Fee: $250

Registration Information

Registrant Name:

Name Preference for Name Tag:

Title:

Specialty:

Organization:

Are you a speaker for the Faculty Development weekend (Friday evening – Sunday morning)?

Yes No

Are you a UWSOM WWAMI student?

Yes No

Which of the following meetings will you be attending?

The Faculty Development Weekend (Friday evening – Sunday morning)?

Yes No

The TRUST/WRITE Faculty Forum - specific to TRUST/WRITE faculty and administrators (Friday morning)

Yes No

The MT WWAMI Faculty Retreat (Friday afternoon)?

Yes No

Home State

Which program are you affiliated with?

If "Other," please specify what organization you are with

Address

City

State

Zip

Phone

Billing information same as above?

Yes No

Do you give your permission for us to share your contact information with other conference attendees and speakers of this conference?

Yes No

Conference Registration per Attendee: $ 250*

* Registration is waived for speakers and UWSOM WWAMI Students.

Meals

Please enter total number of people who plan to attend each meal, including registrant and guests. Guests will be charged for the Saturday evening banquet meal. Attendee meals at conference are included in registration.

Friday Reception
# attending (including you & number of guests) – No Charge

Number of Attendees

Saturday Evening Banquet
# attending (including you & number of guests) – $25 charge is for guests only

Number of Attendees

Dietary restrictions?

Total Registration: $ 250

Banquet Guests

You have selected to pay separately for your guests at the Saturday Evening Banquet. After finishing payment for your registration, you will be directed to a second payment screen to pay for your guests.

Total Guest Registration: $ 0

Please verify that you are human to proceed

For questions about or problems with registration, please contact:

Rachel Norris
Montana AHEC /
Montana Office of Rural Health

Tel: 406-994-6495
Email: rachel.norris@montana.edu