2021 Indigenous Medical School Grads

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Please complete this form so we can celebrate you and your accomplishments at our online Indigenous Medical School Grad Celebration Saturday May 15, 9:00-10:30 AM PST, as well as mail you a token of appreciation for all your hard work. All information is confidential, will not be shared, and will only be used for the purposes of including you in this event.

Email *

Please choose one of the following. If neither apply, please do not continue with the survey: *

I am available to attend the online celebration

I am not available to attend the online celebration but give permission to IPAC to include my name, medical school, where I am from and my future plans in my absence.

First and Last Name *

Medical School *

Where are you from? *

What are your future plans? *

Street Address *

Unit number if applicable *

City *

Province *

Postal Code *

Submit

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