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BMRC Event Medical Questionnaire
Please respond to the following questions if you would like to have the Berkeley Medical Reserve Corps provide medical care at your event. You may always return to:
http://tinyurl.com/BMRCevent
to submit another response.
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* Indicates required question
Email
*
Your email
Event name:
*
Your answer
Event date(s):
*
Your answer
Event time(s):
*
Your answer
Event location(s):
*
Your answer
Name of organization:
*
Your answer
Primary contact name:
*
Your answer
Primary contact phone:
*
Your answer
Primary contact email:
*
Your answer
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