2024 HS Academy (Canadian) Application

General Information
Full Name*

First NameLast Name
Credentials*
MD, DO, etc.
E-mail*
example@example.com
Cell Phone Number*
Preferred Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you attended HS Academy in the past?*

YesNo
Please indicate which year(s) you attended in the past.*

202120222023
Residency Program
Dermatology Training Year*

123
What is the name of your residency program?*
In one sentence, why do you want to attend this event?*
Please wait to book your travel until after you receive your official invitation to attend from our staff.
Should be Empty:

General Information