2023 Innovation Forum Application Form 2023 Innovation Forum Application Form Please complete the following application to participate in the Innovation Forum at the 2023 PeDRA Annual Conference. The Forum is a workshop designed to engage all attendees in learning how to identify problems worth solving and develop innovative solutions for real-world problems. This session will be led and facilitated by Lilit Garibyan, MD, PhD, Kachiu Lee, MD, and Yakir Levin, MD, PhD of the Magic Wand Initiative. The Forum will include a session in the afternoon of Friday, November 10, and a late morning session on Saturday, November 11. To be eligible for participation in the Innovation Forum individuals must be registered for the PeDRA Annual Conference, and submit a patient need or problem worth solving for pediatric dermatology patients to be considered for group discussion. Priority consideration will be given to participants who have clinical experience. It is PeDRA's intention to include all interested attendees in the Innovation Forum. However, applications are required for space and planning purposes, and to verify eligibility*. The deadline to apply is 5 PM PT, Thursday, September 14.*All attendees are welcome to participate including patient advocacy and industry partners. Attendee Information First Name Last Name Email Primary Affiliation Current PositionSenior Clinician and/or InvestigatorMid-Career Clinician and/or Investigator (between 7 and 15 years out of training)Early Career Clinician and/or Investigator (between 2 and 7 years out of training)New Clinician and/or Investigator (within 2 years of finishing training)Clinical FellowResidentResearch FellowCurrent MD/PhD student or equivalentIndustry PartnerParent, Patient, or AdvocateOther Enter other position here: Enter your title or role at your company Do you have a problem that you think is worth solving and would like it to be considered to be discussed at the Forum?YesNo Problem worth solving Problem you'd like to submit to be considered for group discussion. Subject Area (select all that apply) Acne and Hidradenitis Suppurativa Atopic Dermatitis & Psoriasis Birthmarks Connective Tissue and Autoinflammatory Disorders Cross-cutting Drugs & Bugs Genetic Skin Disorders Hair Disorders Neonatal Skin Skin of Color and Pigmentary Disorders Skin Tumors and Reactions to Cancer Therapies Other / Not sure Summary of the problem (50 word maximum) If you do not have a problem that you've identified, please explain your interest in attending the Innovation Forum (50 word maximum) Contact Information Return to Conference Overview
