Registration Form

Mini-Med School 2007 Registration Form

Please note: There is no charge for the program.

Registration Information

* Indicates a required field.

*Name:

Address:

City:

State:

Zip:

*E-mail:

Year of Birth:

Education:

High School

College

Post-Graduate

Please indicate any special needs for participation in and access to this conference.

To participate in the interactive workshops on September 17 and September 24, please indicate your preferred session set. You may sign up for one set of workshops per evening. Each session is twenty-five minutes.
Set One Workshop 1a: Simulated radiation treatment Workshop 1b: Simulated gamma knife
Preferred Date:
Set Two Workshop 2a: Standardized patient interview and physical teaching assistants for cardio and abdominal exam Workshop 2b: Use of simulators
Preferred Date:

Registrants will be notified of acceptance by e-mail on August 23, 2007.

Contact

Char Batten, Executive Assistant
Office of the Senior Associate Dean
Brody School of Medicine at East Carolina University
Brody AD 47
Greenville, NC 27834
battenc@ecu.edu

Phone: 252-744-3078
Fax: 252-744-3073