Dissemination Day 2025 | Event Registration

Registration for Annual Dissemination Day 2025

First Name *

Last Name *

Title

Affiliation/Organization

Phone Number *

Email Address *

Media Release Agreement:
I authorize MetroHealth and the Center for Health Equity Engagement Education and Research to create recordings of my name and/or image.
I understand the recordings may take the form of photographs, films, or any other material.

Yes, I agree to MetroHealth and the Center for Health Equity Engagement Education and Research using my name and/or image for the aforementioned media purposes

No, please do not use my name and/or image in any way.

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