Program Registration To register for the Residency Fair, please complete the following 2 steps: Open Form Registration Form Name of Hospital/Residency Program or Affiliation: * This is how your program name will appear in our program booklet and on all signage. Specialty: * Anesthesiology Boards Preparation Cardiothoracic Surgery Dermatology Diagnostic Radiology Diversity Office Ear Nose and Throat Emergency Medicine Family Medicine General Surgery Internal Medicine Interventional Radiology Med-Peds Neurology OB/GYN Ophthalmology Orthopedic Surgery Pathology Pediatrics Physical Medicine and Rehabilitation Psychiatry Radiation Oncology Research Other If Other, Indicate Specialty or Affiliation: Program Director: * Please provide name with credentials First Name Last Name Program Address: * Address 1 Address 2 City State/Province Zip/Postal Code Country Program Email Address: * On Site Representative 1: Name * First Name Last Name Email: * On Site Representative 2 (optional): Name First Name Last Name Email: Alumni Participation Will a HUCM Alumni be in attendance to represent your program? * Yes No If Yes, please list their name(s): Special Circumstances/Additions: Please describe here any information that is not included on this form that may impact your participation e.g. special payment process required by university or program policies, special activities, multiple program specialties or additional representatives (example format: 1. specialty - name1; 2. specialty - name2; 3. specialty - name3). Participation Agreement: * By submitting this application, I acknowledge and agree on behalf of myself and the residency training program: 1. The Howard University College of Medicine (HUCM) is organizing the 2025 Residency Fair for the convenience of residency programs and HUCM students. 2. The fact that students, residents and/or training programs are permitted to participate in the Residency Fair does not constitute an endorsement of their qualifications and no advertisements or announcements implying such endorsements will be permitted. 3. The Residency Program participating agrees to hold harmless, and shall not seek remedy from the Howard University College of Medicine. 4. The Residency Program understands that the Howard University College of Medicine has disclaimed all liability for damages, costs and expenses, including legal fees that may be incurred because of its participation in the Residency Fair. I agree I do NOT agree Thank you! Please expect email correspondence from howardmed.residencyfair@gmail.com for any additional processing required. Step 1: Complete this registration form to submit information about your program(s) Step 2: Indicate Residency Fair table selection(s) and ad space in the program booklet Navigate All registration forms and table selections must be received by 11:59 pm EST on February 15, 2025, unless special arrangements have been made in advance.
