ONLINE EVENT REGISTRATION
Make sure to submit this form at least one month before event starting date
KSU'S CLINICAL SKILLS AND SIMULATION CENTER
Title of suggested event *
Write 3 to 5 learning objectives for you Event *
Write a brief description for your event *
Target Audience *
Length of the Event *
Tentative dates *
MM
/
DD
/
YYYY
Number of participants( Minimum - Maximum) *
Type of Learners *
Speciality *
Logistics, Medical Equipments are needed: *
If yes, Please specify: *
Number of training rooms : *
Number of Lecture Rooms
Simulation Modality (its) is\are needed *
Support Services: *
If others, please specify *
Requester Initials:
Date of submission:
MM
/
DD
/
YYYY
Email address *
Mobile Number
Submit
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