Step 2: Create Account - Black Men In Medicine

To create account you must start here and verify your email address. If you have already completed that step and did not receive an email with a validation code please click here to submit a support ticket.

You should have received an email at containing a verification code, if it has been over 10 minutes and you have not received the email click here to submit a support ticket.

Validation Code

Enter the verification code sent to your email.

The code you entered is incorrect.

Username*

Email*

Account Type*

Password*

Enter Password Confirm Password

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Your Career Path

Let others in the community know where you are currently practicing. You'll have the opportunity to add additional past career history after your account has been created.

Note: This information will be publicly visible to the community, if this is of concern to you please contact us here.

Employer Name*

What is the name of the institution where you are employed.

Start Date*

When did you start this position?

End Date

Leave field blank if you are currently practicing here.

Employment Type*

What category would this be considered?

Description

Write a brief description of your experience here.

Your Educational Path

Let others in the community know where you are (or have) studied medicine. You'll have the opportunity to add additional educational history after your account has been created.

Note: This information will be publicly visible to the community, if this is of concern to you please contact us here.

University/Program Name*

Education Type*

Start Date*

End Date

Display Name

How would you like your name to appear on the site?

Your Bio*

Tell the community a bit about yourself and your experience. (note: This will be displayed publicly)

Interest in BMIM

In a few words, explain what do you hope to get out of the BMIM Network and/or what do you hope to contribute to the community as a whole.

Terms and Conditions*

I agree to BMIM's Community Guidelines, Terms and Conditions, and Privacy Policy

Name

Prefix First Last Suffix

Phone

This field is for validation purposes and should be left unchanged.

Your Career Path

Your Educational Path

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