2023 Innovation Forum Registration Form 2023 Innovation Forum Registration Form Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: We invite you to join us for the Innovation Forum taking place at the 11th PeDRA Annual Conference, November 9-11, 2023. The Innovation Forum is a workshop designed to engage Conference attendees in learning how to identify important real-world problems related to pediatric dermatology and ways to develop innovative solutions to solve them. Led and facilitated by Lilit Garibyan, MD, PhD, Kachiu Lee, MD, and Yakir Levin, MD, PhD of the Magic Wand Initiative. The deadline to enroll is 5 PM PT, Thursday, October 12. In what capacity would you like to participate in the 2023 Innovation Forum? Attendees who select option 1 will need to provide a problem worth solving suggestion in this Registration Form. Select option 2 if you do not have a problem worth solving to submit, but would like to attend the Innovation Forum and receive any potential updates regarding the forum. Option 1: I would like to be an active participant and have a problem worth solving to submit. The first 60 people to sign up will be included as active participants. Open to clinical fellows and above. All attendees, including medical students and residents are welcome to observe the session, but may not participate in the individual groups. Option 2: I would like to be an audience member with the opportunity to observe and vote on the problems presented by the workshop participants. There is no limit to the number of people who can observe the workshop. Are you interested in joining a collaborative workgroup focused on researching cutaneous manifestations of neurofibromatosis type-1 (NF1) during the Innovative Forum and possibly beyond? This group will have around 30 minutes to meet at 4:15 PM Thursday. Subsequent virtual meetings to be arranged after the conference, or would you like to submit your own problem worth solving?Yes, I would like to join this group.No, not at this time. Please explain your interest in cutaneous neurofibromas treatments. (50 word maximum) First Name Last Name Email Primary Affiliation Enter your title or role at your organization 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 FellowOther Enter other position here: Problem Worth Solving Please submit the problem you think is worth solving: (50 word maximum) 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 Why are you passionate about this problem? (50 word maximum) What are the main barriers you face in trying to solve this problem? Check all that apply.Lack of fundingLack of institutional supportLack of mentors in this areaLack of industry supportLack of education and trainingOther Please specify: Save my progress and resume later | Resume a previously saved form Contact Information Return to Conference Overview
