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SESSION 6: REGISTRATION FORM: FALL 2023 - SPRING 2024
FILL OUT THIS QUICK FORM TO APPLY FOR ENROLLMENT FOR THE WEST COAST CHAPTER OF MEDITALKS AND THOUGHTS (SESSION 6)! THIS FORM IS REQUIRED FOR BOTH NEWCOMERS AND RETURNERS FROM SESSION 5. By filling out this form, you are only committed to attending the first meeting of the session and can choose to discontinue afterward if the program does not appeal to you. Thank you!

The Introduction Meeting is on Saturday, October 21st! via Zoom!
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What is your first and last name? *
What email address could we best reach you by? *
What is your phone number? *
Which school and state are you from? *
What is your grade level for the 2023-2024 school year? *
Why are you interested in joining MEDItalks and Thoughts? (no need for complete sentences) *
How did you find out about our program and organization? If you were referred by someone, please mention their name.
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Any additional questions, comments, or concerns (like any timing issues/conflicts, etc)?
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