WMS Elective Registration
Please fill out this form in addition to submitting the .pdf to the WMS
Email address *
I am registering for the: *
Last Name: *
Your answer
First Name: *
Your answer
Preferred Email *
Your answer
Phone Number *
Your answer
I am a: *
Medical School/ Residency Program *
Your answer
Medical Specialty (or intended specialty) *
Your answer
Dietary Restrictions (list food allergies under other) *
Where did you hear about the elective? *
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