LIDEReS 2023 Speaker & Moderator Registration

Dear LIDEReS Moderator/Speaker,

Thank you for being an integral part of the Latino Medical Student Association (LMSA) and our inaugural National Center for LMSA Leadershiip & Advancement. As you know, this initiative aims to provide physicians, faculty members, staff, and healthcare professionals with resources for their continual development as leaders in medicine.

The first Center event of the new year is our LIDEReS program: The Latina/o/x Identity, Development, Empowerment, and Resources Seminar. This two-day seminar brings together faculty (including residents with signed contracts for faculty positions and fellows) and physician advisors from across the United States and provides participants with inspirational and practical guidance and tools for pursuing career advancement in academic medicine. The seminar will help participants develop key professional competencies that build self-efficacy, communication skills, and leadership while expanding their network of colleagues, role models, advisors, and champions.

This year's LIDEReS session will take place virtually on February 16-18, 2023 (Thursday - Saturday). Events on each day will occur from 8:00 am to 5:00 pm Moutain Time. Continuing Medical Education (CME) credits will be provided.

Please use this form to register for the event. This form may only be used to register individual moderators or speakers. To register one or more participants (who are not serving as moderators or speakers), please use the participant registration form.

Additionally, please note that, in serving as a moderator or speaker for the 2023 LIDEReS program, your registration does not count against the number of complimentary LIDEReS registrations afforded to institutional members of the National Center for LMSA Leadership & Advancement. There is no charge for your participation in this program.

Lastly, after completing this form, all registrants will receive a Zoom meeting link and a pre-event survey to complete as soon as possible. Please look out for email communications from center@lmsa.net.

For any questions regarding this form, the LIDEReS seminar, or the National Center, please reach out to center@lmsa.net; dlellis@salud.unm.edu. We look forward to having you at this year's event.

Date

Please indicate your role in this year's LIDEReS program. *

Speaker Moderator Honoree

Please provide information for the form respondent - the individual completing this form - wherever it says "Contact Person." This is true if you are registering yourself or if you are registering on behalf of another individual.

Contact Person Name *

First Name Last Name

Contact Person Email Address *

example@example.com

Contact Person Phone Number *

Please enter a valid phone number.

Institution Name *

Is your institution a member of the National Center for LMSA Leadership & Advancement? *

Yes No Unsure

Would you like to speak with someone regarding becoming an institutional member of the National Center for LMSA Leadership & Advancement?

Yes No

Please enter contact information for the registrant below (maximum entry of 1). Make sure to click "SAVE" below after entering the registrant's information. Please complete this question even if you are registering yourself and have already provided your information above. *

Participant Number

The number of participants you have entered above is not equal to 1. This form cannot be submitted unless the name and email address for only 1 speaker/moderator have been provided. Please correct this discrepancy before proceeding. Thank you.

Please use this space to provide any questions, comments, or concerns, or to request any accommodations necessary for you to participate in this LMSA event.

By submitting this form, you confirm that you have:

Read, understood, and agreed to the LMSA National Event Terms & Conditions ;
Provided information in this form that is truthful, accurate, and complete; and
Agreed to attend this program to the best of your ability.

Please hit "Submit" below to complete this registration form. Form submissions will be reviewed for completeness and approved or rejected within 72 hours. For any questions, please contact center@lmsa.net.

NOTE: If the Submit button does not appear below, there is an error in your form responses above. Please ensure that you have provided registrant information and clicked "SAVE."

LIDEReS 2023 Registration - Moderators & Speakers