2024 Registration Form

Registration Form

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Please complete the following form to register for the 2024 PeDRA Annual Conference. If you have questions or encounter any trouble with the form, please email conference@pedraresearch.org or call 971-369-4690.

Please note that you can save your progress on the form and return later by clicking "Save my progress and resume later," located at either the top or bottom of the form.

ATTENTION MEDICAL STUDENTS AND RESEARCH FELLOWS: You are not eligible to register for Conference using this form until you receive acceptance into the NextGen Research Forum. All medical students interested in attending the 2024 PeDRA Annual Conference were required to submit an application for the NextGen Research Forum by 11:59PM on Thursday, August 1, 2024. PeDRA is no longer accepting applications for the NextGen Research Forum. If you have questions, please contact us.

The Conference will be held at the Sheraton Phoenix Downtown Hotel, 340 North 3rd Street, Phoenix, AZ 85004. Please click here to make your reservation by October 1, 2024.

Attendees under the age of eighteen (18), this form must be filled out by a parent or guardian over the age of eighteen (18). A separate form must be completed for each Conference attendee, including children under the age of eighteen (18) who plan to attend the Conference.

Registration Details

Please select your registration category:

Note to industry partners – industry participation at the 2024 PeDRA Annual Conference will be limited to representatives from the PeDRA Corporate Council or companies supporting the conference. Eligible companies will be provided with a code for a select number of representatives to register using the non-member category. Please email Mike Siegel, PhD with any questions about industry registration, the PeDRA Corporate Council, or conference support opportunities.

Only exhibitors attending the conference in a limited capacity as part of an organization or company with an exhibit table should use this category. If that is you, please proceed. If not, and you are unsure of the registration category you should use, please email us.

Please select what most accurately describes your current position:

Senior 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)Other

Please specify:

Please select what most accurately describes your current position:

Clinical FellowResidentOther

Please specify:

Only medical students and research fellows who have been accepted to attend the NextGen Research Forum and have received a registration code are allowed to proceed. The deadline to apply for NextGen was 11:59PM PT on Thursday, August 1, 2024. PeDRA is no longer accepting applications for NextGen. Medical student and research fellow attendance to the PeDRA Conference outside of the NextGen Research Forum is not permitted. If you have questions, please contact us.

Have you been accepted to attend the NextGen Research Forum, and do you have a registration code?

Yes

Enter the complimentary registration code here:

This is case-sensitive.

Are you a:

Medical StudentPre-graduate Research FellowOther

Please Specify

Which stakeholder group best describes you?

Government AgencyIndustry Partner (please note, registration for the 2024 PeDRA Annual Conference will be limited to representatives from the PeDRA Corporate Council or companies supporting the conference PeDRA 2024 PeDRA Annual Conference. If you have questions, please email Mike Siegel, PhD).Patient Advocacy PartnerOther

Other - please describe

Please tell us more about yourself. Select all that apply:

I am the parent or guardian of a patient under the age of 18, registering on my own behalf.I am the parent or guardian of a patient under the age of 18, registering on their behalf. Please fill out a separate registration form for each child you are registering.I am a representative from a patient advocacy organization.I am a patient (over the age of 18).

Attendee Information

Please provide your name exactly how you would like it to be printed on your conference badge and listed on the conference app.

First Name

Last Name

Please provide any credentials you would like listed on your conference badge:

Please indicate your desired pronouns to be listed on your conference badge.

Other - please describe

Primary Affiliation

Note: This will appear on your conference badge exactly as you enter it. Please write out the full institution or organization name instead of using acronyms or abbreviations.

If applicable, please provide the name of the organization or patient community with which you are involved.

Email Address

Note: This email will be used to grant you access to the PeDRA Conference App. If you are a PeDRA member, please provide the email address associated with your PeDRA membership profile.

Current Street Address

City

Country

State

State/Province

Province

Postal Code

What type of address is this?

PersonalBusinessOther

Please indicate any special dietary needs you may have:

NoneVegetarianKosherOther

Other special dietary needs:

Demographics

PeDRA is committed to supporting equity, diversity, and inclusion across all facets of its organization, programs, committees, leadership, and research studies. We ask for demographic information from PeDRA Annual Conference attendees to ensure we have accurate and complete data to help achieve this goal. All data collected is kept safely and only de-identified aggregate data may be shared for strategic purposes.

Please specify your gender:

FemaleMaleNon-binaryI do not wish to provide this information.

With what race(s) do you self-identify? Please select all that apply.

American Indian or Alaska Native	Asian
Black or African American	Hispanic or Latinx
Middle Eastern or Northern African	Native Hawaiian or other Pacific Islander
White	Other - write in
I do not wish to provide this information.

Other - write in race:

Accessibility and Special Needs

Pursuant to the Americans with Disability Act (ADA), do you and/or the individual(s) you are registering for have any special needs or requirements?

Special Events and Activities

Please indicate your interest in participating in the following PeDRA Conference Special Activities:

Note that requests for 1:1 consultations are no longer being accepted due to scheduling limitations.

Breakout Sessions provide the opportunity for PeDRA's collaborative Focused Study Groups (FSGs) to come together in person to discuss research ideas across different areas of study. Which of the following, if any, FSG Breakout Sessions do you plan to attend during this year’s Conference? Select all that apply.

Acne/HSAD/PsoriasisBirthmarksConnective Tissue DiseaseDrugs & BugsEducation Genetics (includes Down syndrome subgroup)Hair DisordersNeonatal SkinSkin of Color & Pigmentary DisordersSkin Tumors and Reactions to Cancer Therapies (STARC)I'm not interested in attending the PeDRA FSG Breakout Sessions.

Early Investigator (EI) Forum, reception on Thursday, October 24, and session on Friday October 25? Please note that the 2024 EI Forum is closed to students or other trainees prior to graduating from medical school and to anyone more than 7 years post training. Click here to learn more about the EI Forum.

YesNo

NextGen Research Forum presentations taking place at 8:00 AM of Friday, October 25. Faculty are encouraged to attend. Click here to learn more about the NextGen Research Forum.

YesNo

1:1 consultations from expert faculty to discuss:

Biostatistics Consult with PeDRA's Biostatistician, Amy Buros Stein, PhDPeDRA Grants ConsultationI am not interested in 1:1 consultations.Please note: Expressing interest in a consultation does not guarantee a 1:1 session during the Annual Conference. Expert consultations will be scheduled according to the order of requests received, preferences listed, and availability of expert faculty. Priority will be given to investigators working on active PeDRA Studies and Early Career Investigators. Attendees invited to participate in a 1:1 consultation may be required to bring pre-prepared materials to the consultation as a condition of participation (e.g. a project outline).

Hosted Networking Dinner Reception and Karaoke on Friday, October 25:

YesNo

Underrepresented in Medicine (URiM) networking mingle on Friday, October 25, 6:30-7:15 PM local time before attending the main reception.

YesNo

4th Annual Dash for Discovery Fun Run/Walk on Saturday morning, October 26. Please note, a separate registration form is required for the Dash. Further details and the registration form can be found here.

YesNo

Yoga Sessions Friday and/or Saturday morning(s).

YesNo

Skill-building workshops from 5:30-6:30 PM local time, running concurrently on Friday, October 25:

Using Neighborhood Atlas with Lisa Arkin, MDApproaching Large Databases with an Equity Mindset with Lucinda Kohn, MD & Joy Wan, MDI am not interested in joining a skill-building workshop.

Are you bringing your child(ren) and would you like to sign them up to attend Mini Camp Wonder in the afternoon on Friday, October 25? You can fill out the Camp Wonder Registration Form here.

YesNo

Industry Representative Attestation

As is the case for all attendees at the PeDRA Annual Conference, industry representatives are expected to respect the open, collaborative environment that PeDRA is committed to providing at its conference, and to prioritize the advancement of PeDRA's mission and vision during their time as a conference attendee. Industry representatives are free and encouraged to engage in activities throughout the main conference agenda including plenary sessions, networking events, poster sessions, and exhibits, and are encouraged to make connections with other attendees at the conference through in-person interaction and the conference app. Industry representatives are further encouraged to review the 2024 PeDRA Annual Conference Prospectus for a full list of company partnership opportunities to get the most value out of their experience.

In addition to the activities listed above, the PeDRA Annual Conference includes a series of breakout sessions intended as venues for PeDRA investigators, trainees, and patient partners to discuss new and ongoing collaborative studies, share ideas, build collaborations, and overcome obstacles. PeDRA recognizes the critical importance of industry collaboration in the research process and hopes that industry representatives are able to engage in as much breakout session time as possible. However, due to the potentially sensitive nature of the discussions taking place, these sessions may be open or closed to industry representatives, for some or all of their scheduled time, at the discretion of the breakout session chair. When participating in a breakout session, industry representatives are expected to engage as learners, listeners, creative scientists, experienced advocates, and active or potential collaborators. In no case, shall a breakout session be a forum for commercial messaging, advertising, promotion, solicitation, or dissemination of clinical trial data. PeDRA reserves the right to ask participants to leave a breakout session if this expectation is not being met.

By checking this box I certify that I have read and understand this statement. Agreeing to this statement is a requirement for any Industry Representative interested in attending the conference. To be eligible to join any open breakout session(s) all attendees must also agree to the PeDRA Confidentiality Agreement near the bottom of this form. Please contact PeDRA's Executive Director, Mike Siegel, with any questions or concerns.

Photography and Videography Agreement

PeDRA may capture photographs and video during the 2024 Annual Conference. Click here to view the PeDRA Photography and Videography Agreement. By this release, I consent to the use of my likeness in such photograph(s) perpetually and for all media worldwide (including print, Internet, and any other electronic medium). I understand and agree that I shall receive no compensation for the use of my likeness, voice, and name in such media. I am over eighteen (18) years or age. If I am also registering on behalf of someone under eighteen (18) years of age, I represent that I am the parent or guardian of such person. I hereby consent to the foregoing on his/her behalf.

I agree

I do not agree, however, I acknowledge having read this Photography and Videography Release and that my likeness and voice, or that of someone under the age of eighteen (18) for whom I am registering, may appear in photos or videos of group settings or public areas that are used by PeDRA for advertising, video or audio recordings, printed publications, internet publications, or in any other medium for a related purpose, perpetually and for all media throughout the world.

Confidentiality Agreement

PeDRA is committed to protecting confidential and sensitive information related to unpublished research ideas, methods, data, results, and proposals shared at the Annual Conference. Click here to view the PeDRA Confidentiality Agreement.

By checking this box I certify that I have read and will abide by PeDRA's Confidentiality Agreement as an attendee at the 2024 Annual Conference. Checking this box is optional, but is a requirement for any attendee interested in joining one or more of the Breakout Sessions.

Acknowledgment of Personal Responsibility

PeDRA is committed to providing a safe and healthy environment for all conference attendees, exhibitors, partners, and the administrative team. Click here to view the PeDRA Acknowledgement of Responsibility.

With my response below, I release PeDRA and its Meetings Committee, Board of Directors, staff, and contractors from liability should I become ill, directly or indirectly, as a result of my participation in this event.

I acknowledge personal responsibility.

I am registering on behalf of someone under eighteen (18) years of age, I represent that I am the parent or guardian of such person. I hereby accept personal responsibility on his/her behalf.

Information Sharing

You have the opportunity to share your name, affiliation, and email with other conference attendees through the conference program/app. The information would be visible to all attendees, including PeDRA members, industry and patient partners, non-members, and trainees. *

I acknowledge that my information (name, affiliation, email) will be visible to other PeDRA attendees by using the Conference app.I do not wish to share my information and understand that will mean I will not be using the Conference app to access the Conference agenda, game, and other information and/or activities.

In addition to conference updates, do you wish to receive regular updates from PeDRA via email?

Yes I already receive PeDRA emails.No, I don't want to receive any communications outside of conference-specific details.

Do you have a complimentary registration code?

Yes, I have a complimentary registration code.No

Enter the complimentary registration code here:

This is case-sensitive.

PeDRA is proud to be offering Travel Scholarships of up to $595 to help offset travel costs for residents, clinical fellows, as well as patients, parents, and advocates, to attend the 2024 PeDRA Annual Conference. Attendees from these categories often lack the resources to attend events like this, but are critical to PeDRA's goal of mobilizing a diverse and collaborative network to improve patient lives through research. We invite you to add a donation to your conference registration to help support us in this effort.

Yes, I would like to add a donation in support of 2024 Travel Scholarships.No, I do not wish to add a donation to my registration.Please note that PeDRA is a 501(c)(3) nonprofit organization and your donation will be tax deductible to the extent allowable by law. PeDRA's EIN is 84-2173231. All donations received will be used in direct support of 2024 Travel Scholarships.

Please enter the amount you'd like to donate in support of the 2024 Travel Scholarships below:

Please enter the amount in USD. Do not include any symbols (i.e. "$").

PeDRA is proud to be offering Travel Scholarships of up to $595 to help offset travel costs for residents, clinical fellows, as well as patients, parents, and advocates, to attend the 2024 PeDRA Annual Conference. If you would like to apply for this opportunity, please click here and submit your application by August 1, 2024. Additionally, if you would like to contribute to this fund, please select yes below.

Please enter the amount you'd like to donate in support of the 2024 Travel Scholarships below:

Please enter the amount in USD. Do not include any symbols (i.e. "$").

Donation comments

Please use this space to add any notes, comments, or dedications for your donation.

Pre-Discount Total in USD

Discount code

Discount Amount

Total After Discount

Final Total in USD

Payment Information

Name on Card

Card Number

YYYY

Code

Billing Zip code

Billing Email

By clicking "Submit" I authorize PeDRA to charge this card for the Final Total in USD. Cards are not kept on file and will only be charged once. No refunds will be provided after October 11, 2024. Please click here to view the complete Cancellation Policy.

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Registration Form

Please complete the following form to register for the 2024 PeDRA Annual Conference. If you have questions or encounter any trouble with the form, please email conference@pedraresearch.org or call 971-369-4690.

Registration Details

Accessibility and Special Needs

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