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Wilderness Medical Society - SIG Registration Forms (Page 2)

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Wilderness Medical Society - SIG Registration Forms
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

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