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Tell Us About Yourself

Veteran Status*

Indicate all that apply

I am a Caregiver/Spouse/Family Member to a Veteran
I am Active Duty
I am in the National Guard/Army Reserves

Name*

Email*

City

State

Country

Professional Affiliation*

Department of Veterans Affairs
Other Federal Agency
Veterans Service Organizations
Private Sector
Non-Profit Organization
Academia
Press or Media
Not Applicable

How did you hear about iEX?*

Facebook
Twitter
LinkedIn
Meeting
Email
Veteran Service Organization (VSO)
Other

Other, please specify

Veterans Service Organizations - Please specify:

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Tell Us About Your Organization: Veteran Affairs Employees

Department of Veterans Affairs Subdivision

VISN

VA Facility

If you selected “Other,” enter VA facility or Program Office

Job Title

Tell Us About Your Organization: External VA

Organization Name

Department or Division

Job Title

Tell Us What Interests You About the iEX Series

I am interested in:

Veteran-focused innovation
Learning how iEX 2021 can help me achieve my innovation goals
Best practice tools and information about VHA innovations
Networking opportunities

Which Sessions Interests You...

2022 VHA Shark Tank Competition
Interested
iEX Talks
Interested
Panels
Interested
Keynote
Interested
Innovation Stories
Interested

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