Practice Opportunity Day - Exhibitor Registration Form | Georgia Board of Health Care Workforce

Facility/Company Name (required)

Address

Address Line 1 (required)

Facility's physical address

Address Line 2

City (required)

State (required)

Zip Code (required)

Website (required)

Facility's main website address

Counties (required)

Please provide a list of the Georgia counties in which your practice, clinic, hospital, or health system has a physical location.

Contact Person (required)

This individual will be your organization's main point of contact for any residents interested in practicing with your organization.

Phone Number (required)

Email (required)

Contact person's email address

Specialties Recruiting (required)

List all specialties for which you are recruiting.

Date Selection

Upcoming Event Dates

Medical College of Georgia

April 23rd, 2025 Augusta, Georgia

Acknowledgement and Photo Release

I agree

I understand that I am voluntarily providing the following information to the Georgia Board of Health Care Workforce and that it may be distributed to residents and physicians who registered for and/or attended this event. By completing this webform, I acknowledge this potential use of the provided information and allow the Georgia Board of Health Care Workforce to release such information to interested parties. Photographs taken by GBHCW staff at in-person Practice Opportunity Fairs are property of the Georgia Board of Health Care Workforce and may be used in future promotional materials and/or social media. Registration for this event acknowledges this potential use and shall serve as a photo release.