NCSP 2024 Annual Meeting Registration

We look forward to your participation at the NCSP 2024 Annual Meeting! Please note that attendance is by invitation only. Please register by Friday, September 6, 2024.

Please have the following items ready for upload when you register, as the registration form cannot be saved once started.

- A headshot (PNG/JPEG, not exceeding 50 MB)

- Brief biography (200 words maximum)

Personal Information

Credentials (e.g., PhD, MD, etc.)

Institution/Organization

Mobile phone number that you can be reached at during the conference:

Photo (Please attach your headshot as a PNG/JPEG, not exceeding 50 MB)

Do you require any ADA accommodations?

Please specify ADA accommodations:

At the time of the conference, will you require lactation accommodations?

X (formerly Twitter) handle

T-shirt size (unisex style)

Size is not guaranteed; some sizes may have limited availability.

Preferred first name as you would like it to appear on your name badge

Preferred last name as you would like it to appear on your name badge

Pronouns for name badge

Meals and Morning Social Activities

Do you have any dietary restrictions?

Please specify dietary restrictions:

Will you attend the Pre-Conference Dinner on the evening of Monday, November 18, 2024, 6:00 pm-8:00 pm PT, at the UCLA Luskin Conference Center?

Will you attend dinner on the evening of Tuesday, November 19, 2024, 6:30 pm-8:30 pm PT, at the UCLA Faculty Club?

Will you attend dinner on the evening of Wednesday, November 20, 2024, 6:30 pm-8:30 pm PT, at the Annenberg Community Beach House? Transportation will be provided.

Please select any on-site, morning social activities below in which you are interested in participating:

Morning Fun Run (Tuesday, November 19, 2024, 6 am PT)

Yoga (Wednesday, November 20, 2024, 6 am PT)

Meditation (Thursday, November 21, 2024, 6 am PT)

None of the above

What is your affiliation?

Site (please select one of the following options):

Year (please select one of the following options):

Profession (please select one of the following options):

Primary Specialty: (Please select one):

Program (please select one of the following options):

Fellowship Years (e.g., 2000-2002)
Begin Date: YYYY

Fellowship Years (e.g., 2000-2002)
End Date: YYYY

Speed Mentoring Preferences

On November 20, 2024, from 9:30 am-10:40 am PT, we will be holding a speed mentoring session. Each scholar will have 2-3 scheduled one-on-one speed mentoring meetings (10 to 15 minutes each) with NCSP faculty, alumni, community members, board members, and/or invited conference speakers.
This event is OPT OUT. We expect that you will attend unless you inform us that you cannot make it or are not interested in participating.

Opt out

(Select only if you would like to opt out. Otherwise, we will see you there!)

I would like to opt out of this session.

Please refer to this list of faculty – who are invited but not yet confirmed – and list any you would like to be paired with, if available:

Topics of Interest (Please check all that apply-Current NSCP Scholar):

Please specify which clinical specialty or research related to a clinical specialty (Current NSCP Scholar)

Please specify health policy areas of interest (Current NSCP Scholar)

Please specify non-academic career pathways of interest (Current NSCP Scholar)

Anything else you would like us to know-Current NCSP Scholar?

As NCSP Faculty, your participation is integral to the success of this event!

We have a particular need for speed mentors in surgical fields.

Topics of interest (Please check all that apply-Current NSCP Faculty):

Please specify which clinical specialty or research related to a clinical specialty (Current NSCP Faculty)

Please specify health policy areas of interest (Current NSCP Faculty)

Please specify non-academic career pathways of interest (Current NSCP Faculty)

Anything else you would like us to know-Current NCSP Faculty?

We would love to have you share your wisdom and experience and help build the Clinical Scholars/NCSP network!

(Please note that third-year NCSP scholars who opt to participate will be included in the mentee pool.)

We have a particular need for speed mentors in surgical fields.

Topics of interest:- (Please check all that apply-Alum)

Please specify which clinical specialty or research related to a clinical specialty (Alum)

Please specify health policy areas of interest (Alum)

Please specify non-academic career pathways of interest (Alum)

Anything else you would like us to know-Alum?

We would love to have you share your wisdom and experience and help build the Clinical Scholars/NCSP network!

We have a particular need for speed mentors in surgical fields.

Topics of interest (Please check all that apply-Speaker)

Please specify which clinical specialty or research related to a clinical specialty (Speaker)

Please specify health policy areas of interest (Speaker)

Please specify non-academic career pathways of interest (Speaker)

Anything else you would like us to know-Speaker?

We would love to have you share your wisdom and experience and help build the Clinical Scholars/NCSP network!

We have a particular need for speed mentors in surgical fields.

Topics of interest: (Please select all that apply-NCSP National Program Board Member)

Please specify which clinical specialty or research related to a clinical specialty (NCSP National Program Board Member)

Please specify health policy areas of interest (NCSP National Program Board Member)

Please specify non-academic career pathways of interest (NCSP National Program Board Member)

Anything else you would like us to know-NCSP National Program Board Member?

We would love to have you share your wisdom and experience and help build the Clinical Scholars/NCSP network!

We have a particular need for speed mentors in surgical fields.

Topics of Interest (Please check all that apply-Guest):-

Please specify which clinical specialty or research related to a clinical specialty (Guest)

Please specify health policy areas of interest (Guest)

Please specify non-academic career pathways of interest (Guest)

Anything else you would like us to know-Guest?

Release and Assumption of Risk

As an in-person attendee of the NCSP 2024 Annual Meeting (Los Angeles, CA), I acknowledge that I cannot hold NCSP, its partners, sponsors, and staff liable should I contract COVID-19 or other illness, sustain injury, or for expenses incurred if I need to cancel due to travel restrictions imposed by local, state, national or international jurisdictions.

I acknowledge and understand the following:

1. Participation in the NCSP 2024 Annual Meeting includes possible exposure to and illness from infectious diseases, including but not limited to COVID-19. While adhering to recommended safety procedures and personal discipline may reduce this risk, the risk of serious illness and death does exist.

2. I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19, even if arising from the negligence or fault of the Released Parties.

3. I hereby knowingly assume the risk of injury, harm, and loss associated with the NCSP 2024 Annual Meeting, including any injury, harm, or loss caused by the negligence, fault, or conduct of any kind on the part of the Released Parties.

I AGREE TO THE RELEASE AND ASSUMPTION OF RISK.

Yes

By registering to attend the National Clinician Scholars Program 2024 Annual Meeting, and in connection with my participation in the Meeting, I consent to the use of my name, photograph, video or other likeness in the promotional and other materials of the Meeting without payment or other consideration made to me. I waive the right to inspect or approve any such use of my name or likeness. I expressly release the Meeting sponsors, their trustees, officers, agents, employees, licensees, and assignees, from any and all claims, including copyright, privacy, and defamation arising out of any exhibition, publication, or promotion of this Meeting. I understand that the Meeting may also be available on the sponsors’ websites and archived formats.

I AGREE TO THE CONSENT AND RELEASE STATEMENT.

Yes

Alumni are offered a greatly reduced, non-refundable conference registration fee of $325. Registration will not be considered complete until payment is made.

Please make your payment via credit card at the following link by Friday, September 6, 2024:

https://commerce.cashnet.com/41557NCSP

You will receive a separate registration confirmation from annualmeeting@nationalcsp.org within one to two business days after payment has been made.

I ACKNOWLEDGE THAT MY REGISTRATION WILL NOT BE COMPLETE UNTIL I HAVE PAID THE ALUMNI REGISTRATION FEE OF $325 BY SEPTEMBER 6, 2024.

Yes

Please review and submit your registration

Registration Form

Welcome!

Personal Information

Name Badge

Meals and Morning Social Activities

Affiliation

Speed Mentoring Preferences

Release and Assumption of Risk

Payment