MDL Partner Registration

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If you clicked on a direct link to this form, please click the following link to access information and the complete registration process: https://www.wichita.edu/research/mdl/testing_partner_reg.php

NOTE: DUE TO HIGH VOLUME, PLEASE ALLOW FIVE BUSINESS DAYS TO PROCESS YOUR REQUEST, THANK YOU!

Questions? email: mdl@wichita.edu

Please register below with the professional email and contact information from your organization. When contacting WSU MDL with questions or comments, please make sure to reference the organization that you are representing.

Email *

Organization Name *

Organizational Type *

First Responders & Front Line Health Care

Long Term Care Facility

Kansas School

KDHE Registered (CTP) Community Testing Partner

Community

Street Address 1 *

Street Address 2

City *

County *

State *

Zip Code *

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