Event Title Event Location Event Date Event Date: Year Year202020212022202320242025 Event Date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Event Date: Day Day12345678910111213141516171819202122232425262728293031 If a date has not yet been set, please select an expected time frame for the event: - None -0-30 Days1-2 months3-6 months Greater than 6 months Type of Event - Select -Course ConsultationCourse LectureSeminarWorkshopSpecial EventRecurring MeetingConference (Multiple Speakers)Other Education/Training EventPanelPresentationOther Career Development Event Topic of Presentation Length of Presentation - Select -30 Minutes1 Hour1.5 Hours2 HoursGreater than 2 hours Audience General Public Undergraduate Students Graduate Students and Post-Docs Medical Students, Residents, and Fellows Research Coordinators Regulatory Staff Principal Investigators/Medical Professionals Industry Professionals Audience Size 0-10 11-25 26-50 51-100 101-150 150+ Name of Contact Person Organizational Name Contact Phone Number Email Address Please give a brief description of your organization: Is this event being sponsored by a Duke entity? - Select -YesNo Is your organization affiliated with the Clinical and Translational Science Awards (CTSA) Program? - Select -YesNoUnsure If you have previously worked with an ORAQ staff member, please provide their email address: ORAQ Presenter (to be completed by ORAQ once assigned) This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
