The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

V3sP5hGfc56opQ2UuQtUSuzLcy2ALwMGuVWcvbehPRdcvWxaUMwu5XuCfXBpbxkKz7AAXoa7kMhJGoDBPrvXchmSBYXvKWFZU86U565WV2M

MR3 Network 2022 Retreat Registration

Thank you for your interest in the MR3 Network's second annual scientific retreat, "Rehabilitation Clinical Trials: Innovations, Designs, and Tribulations," to be presented via Zoom on September 29 and 30, 2022.

To register for attendance, please provide us with some further information about yourself.

Registration is a two-part process in order to protect your privacy by sending as little data to Zoom as possible. This also enhances privacy and security by greatly reducing the chance of unwanted attendees.

First, please complete our secure registration form below. Upon submission of this form, your browser will be redirected to Zoom.us to complete the second step. Give Zoom your name and email address to receive your personalized link to the workshop.

Please do not share your personal Zoom link with anyone, but please do feel free to share this registration form!

If you have trouble with registration, do not receive an email confirmation with your personalized Zoom link, or have other concerns, please email Chris Schachte, schachtc@musc.edu.

First Name

* must provide value

Last Name

* must provide value

The retreat may offer breakout sessions for attendees to meet and discuss in smaller groups. Do you have any suggestions or requests for breakout session topics?

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The following questions survey demographics and membership in underrepresented groups. The information will not be published or shared except in anonymous, aggregate form pursuant to NIH-funded training reporting requirements.

Are you Hispanic or Latino?

* must provide value

Yes

Prefer not to answer

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What is your race?

* must provide value

American Indian/Alaska Native

Asian

Native Hawaiian or other Pacific Islander

Black or African American

White

More than one race

Prefer not to answer

reset

Do you have a disability?

* must provide value

Yes

Prefer not to answer

reset

Please tell us the academic credentials/degrees you have attained (e.g., M.D., Ph.D., PT, OT, etc.).

* must provide value

Please tell us the academic ranks/titles you have attained (e.g., Assistant Professor, Investigator, Lead Lab Technologist, etc.).

* must provide value

Please list your current institutional and departmental affiliation(s).

* must provide value

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Please select the state in which the primary institution with which you are affiliated is located.

* must provide value

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.