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2018 TRIP to YALE MEDICAL SCHOOL: REGISTRATION PAGE
Date: April 18, 2018
Dress appropriately (no hats, T-shirts etc.)
Last Name *
Your answer
First Name: *
Your answer
Banner ID#: *
You MUST include the "@" symbol before your Banner ID!       Example: @13579111                                   Do NOT include NVCC.commnet etc.                                               
Your answer
Phone: *
Format: XXX-XXX-XXXX; NOTE: No parentheses around the area code
Your answer
Best Email: *
Your answer
Requesting a seat on the bus (as long as seating is available)? *
Required
Completed A&P II with at least a "C+" or are currently taking this semester? *
Required
Who is your instructor? *
(LAST NAME only)
Your answer
Are you currently enrolled in an Allied Health program? *
If yes, which program?:
Your answer
LAST NAME *
Emergency Contact
Your answer
FIRST NAME *
Emergency Contact
Your answer
PHONE NUMBER #1 *
Emergency Contact; use XXX-XXX-XXXX format (No parentheses). Follow instructions EXACTLY!
Your answer
PHONE NUMBER #2
Emergency Contact; use XXX-XXX-XXXX format (No parentheses). Follow instructions EXACTLY!
Your answer
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