Wilderness Medical Society SIG Registration Forms Page 2
Institution: University of
Academic Year: 2004
College of Medicine
SIG Information Form
SIG Leader:
Alternate SIG Point of Contact:
(POC for all correspondence and WMS Journal)
Name:
Name:
Address:
Address:
Telephone:
Telephone:
E-mail:
E-mail:
Note: SIG Leader name and email address will
be posted on the WMS SIG Website
Faculty Advisor:
Dean of Students Office
Name:
Name:
Address:
Address:
Telephone:
E-mail:
Telephone:
E-mail:
Please send forms to:
Wilderness Medical Society
5390 N. Academy Blvd Suite 310
Colorado Springs, CO 80918
v. 6-Apr-04
Page 2
