Summer Research Seminar Registration

Name

Institution

Address

Phone ( )

E-mail

Do you have any research questions you would like to have answered in the format of this program?

Registration Type

  KUSM-W Affiliate ($0)
  Faculty Resident Student  Staff Other

  Other ($50)
  Faculty Resident Student   Staff Other

Amount Paid

Make check payable to: WCGME

(Please send registration payment by August 11, 2008)

Wichita Center for Graduate Medical Education
1010 N. Kansas
Wichita, KS 67214
Fax: (316) 293-1893
Phone: (316) 293-2665