Transforming Women's Health Outcomes through Engineering:
Participant Nomination Form

General Background

Prefix

Nominee First Name

Nominee Last Name

Title

Organization

Phone

Professional Background

Primary Discipline or Type of Engineering

Sector

Career Stage (Years since terminal degree)

Link to biography/CV/LinkedIn

Event Scope

Nominees are strongly encouraged to submit short answers that articulate their thoughts on the event theme.

ERVA and the thematic task force advising the technical scope of the event will use this information to support the selection process.

Attendance at the event is limited. Approved candidates will be invited to attend.

Brief statement: How can your participation make an impact?

Please briefly describe, from your perspective, how engineering research could transform women's health technologies.

Nominator Information

Nominated/Reviewed by

Send me a copy of my responses

General Background