RSVP for 2016 Central Clinical School (CCS) Public Lecture: "Innovative systems of trauma care"
You are RSVPing to the CCS Public Lecture,  6.00 - 8.00 pm, Wednesday 12 October 2016, being given by Professor Mark Fitzgerald, Director of Trauma Services at The Alfred and Director of the National Trauma Research Institute. It is being held at the AMREP Lecture Theatre between the BakerIDI & Burnet Institute, 75-85 Commercial Rd, Melbourne VIC 3004. See details at http://www.med.monash.edu.au/cecs/events/2016-public-lecture-fitzgerald.html
Sign in to Google to save your progress. Learn more
First name *
Last name *
Email *
We will confirm your RSVP prior to the lecture and post you a link to the video once published.
Phone number
This is useful in the event that you entered your email incorrectly.
Number of people attending, including yourself, in numerals *
You are welcome to bring one or more people. If just yourself, then please enter '1'.
How did you hear about this event? *
Would you like to receive CCS news and event notifications?
Central Clinical School produces a weekly enews distributed by email, and holds one public lecture annually.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Monash University.

Does this form look suspicious? Report

Google Forms