July 21-23, 2023 Boot Camp Intake

Help us make your event great!

Name
Email
Cell Phone
Emergency Contact Name
Emergency Contact Phone
1. 
Do you have any dietary restrictions?

2. 
Other dietary restriction:

3. 
SMUC respectfully uses photos for marketing and training. If a photo of you is taken, may we use it?

4. 
SMUC respectfully shares names/emails with our sponsor, Pendopharm, and the companies that generously provide the ultrasound machines that we use. May we share yours?

5. 
Do you have any mobility issues, health issues, scheduling concerns, etc?

6. 
Tell us about you! What is your current specialty/main practice type?

7. 
Other practice type:

8. 
Do you have access to an ultrasound machine?

Thank you! We hope you enjoy your Boot Camp!