White Coat Day Registration - North Carolina Medical Society

Register for a White Coat Day

First Name:*

Last Name:*

Home Address:*

Home City:*

Home State:

Home Zip Code:*

Have you attended a White Coat Day in the past?

Yes

I would like my upcoming White Coat Day to be...

Virtual

In-person at the NC General Assembly

No Preference

Date that you would like to attend:*

Time of day:*

Email:*

Daytime Phone:

I am attending as part of my...*

Please share your Twitter handle (if you have one) so that we may share photos from your WCD and tag you in them:

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