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DFA NLC Student & Trainee Submission Form
Email *
Name *
Phone Number *
Please list your medical school or residency program affiliation and year (what school/medical center? MS-III, MD-PhD-6, PGY-1, etc.) *
Have you registered for the NLC? *
Are you aware that you can receive a 30% discount if you recruit a group of at least 10 friends/colleagues from medical school or residency to all register? *
Please email justin.lowenthal@drsforamerica.org with a list of the 10 names who will register to be considered as a group.
Can you help recruit friends and colleagues to register for and attend? *
Please list names of individuals or trainee organizations we can contact to encourage to attend with you.
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