Portrait Gallery Submission Form

1. Please tell us about yourself

Tell us if this is a new introduction, or if you are updating a previously submitted introduction.

Create a New Portrait
Update a Portrait

    Please enter your full name

Please use a narrative format to tell our readers about yourself.  Do not press [Enter] at the end of a line--the text will automatically wrap. Do, however, leave a blank line between paragraphs by pressing the [Enter] key twice.

You can also write the introduction in a word processor like Microsoft Word or WordPerfect, or the Windows Notepad, Wordpad or Windows Write program, and then paste it into this field for submission.  To do this, select the text to be copied in your word processing program, then choose Copy from the Edit menu in your program.  Finally, click in the field below, click the right mouse button, and select "Paste" from the menu.  Your story will appear below.  Please be aware that any formatting (bold, italic, fonts) will be lost.

Please tell us about your special interests and expertise.  Please be specific about your specialty and provide detailed information about research or practice interests.  Again, please do not press [Enter] at the end of each line (the text will automatically wrap in the box), but do press [Enter] twice to leave a blank line between paragraphs.

Entries in the Professional Gallery section of the site will be arranged by specialty (nursing, surgery, electrophysiology, etc.).

2. Contact information

    Hospital/Practice Affiliation

    City, State (or Province), Country

    Telephone Number

    Hospital/Practice URL (Optional)

    Email Address

Would you like your email address to be published on the page?

  Yes, I would like my email address to be published
  No, do not publish my email address

3. Would you like to include a picture?

Each introduction can include a picture.  There are three ways to submit a photo:

1. If a photo is already on the web, enter the URL below.  If there is more than one picture on the page, be sure to specify which picture to use.

2. Email the image to <portraits@tchin.org>.  Be sure to include your name and email address if you're sending it from a different address.

3. Send a print for scanning--the submission address is on the confirmation form that will appear after you submit this page, and please specify if you would like the photo returned.  We can accept prints and 35mm slides/negatives.

Note that you can add or change the photo at any time.  Photographs may be cropped, resized, or resampled to minimize the time your page takes to download. 

    Photo Link or URL (optional):

    Photo comments or instructions (optional):

4. Grant permission for your introduction be published

Please read the statement and then check the box below.  If you don't check this, we will not publish your introduction unless you send an email message to <portraits@tchin.org> granting permission.

5. Additional Comments

If you have any comments, suggestions, or concerns about this site that you'd like to share with us, please enter them below.  These will not be published with the story.

6. Submit the Introduction

Last step: click on the "Submit your Introduction" button below once to send the story.  A confirmation page will be displayed when the story is accepted (please be patient--this may take several seconds).  We'll also send a message to the contact email address above when the story is published.  

Please report any problems with this form to <sysadmin@tchin.org>
This form was last revised on March 09, 2010.