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: to submit another response.
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Email *
Event name: *
Event date(s): *
Event time(s): *
Event location(s): *
Name of organization: *
Primary contact name: *
Primary contact phone: *
Primary contact email: *
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