Social Media Health Network

Bringing the Social Media Revolution to Health Care

Social Media Week at Mayo Clinic Patient/Caregiver Scholarship 2013

See this post for contest details, including how to enter.

[hub_input_form_start class="essay-create"]

[hub_input type="text" label="Name"  required=1]
[hub_input type="text" label="Address" required=1]
[hub_input type="text" label="City" required=1]
[hub_input type="text" label="State/Province" required=1]
[hub_input type="text" label="Zip/Postal Code" required=1]
[hub_input type="text" label="Country" required=1]
[hub_input type="text" label="Phone Number" required=1]

[hub_input type="select" options="Patient||Caregiver||Both" label="I am a" required=1]
[hub_input type="radio" options="No||Yes" default="No" label="I am or have been a patient at Mayo Clinic or in the Mayo Clinic Health System." helptext="If yes, Mayo Clinic patients must sign a separate authorization. Download here and return according to the instructions on the form." required=1]

[hub_input type="checkbox" label="If selected for a scholarship, I am willing to present my story as part of the noon Keynote session at the Social Media Summit on 10/23/13." required=1]
[hub_input type="checkbox" label='I agree to the contest rules.' required=1]

[hub_input type="textarea" label="Essay: What is your patient/caregiver story? Some additional items to include: How would you hope to contribute to the conference discussion as a participant? What do you hope to learn? How would your participation serve the greater good during and after the conference? Also, please describe your experience using social media tools such as Facebook, YouTube, Twitter and blogs. Include links to usernames/profiles and blogs. We recommend typing your response offline and pasting into the textarea when ready to submit." postcontent=1 required=1]

[hub_input_form_end]