Medical Student/Resident Application for DPCMH Conference tuition scholarship
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Name: *
What is your most reachable contact information including stable email address?
Training Program *
Date you will graduate *
What specialty are you planning to practice in? *
How did you hear about our scholarship program? *
How did you first learn about Direct Primary Care? *
Who has been your biggest influence regarding DPC? *
In 500 words or less why do you think Direct Primary Care is a solution for the healthcare system and why are you interested in it. *
If you are awarded a tuition scholarship will you commit to attending the specified DPC conference? You will still have to provide your own travel and hotel arrangements. In some cases, third year residents may have travel and hotel covered. *
Which DPC conference are you applying for? *
Have you filled out an application for free membership to the DPCMH Association? *
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