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High School Students RMEC Sign-Up
The information being collected in this form is being used to register the student for the 2020 Regional Medical Education Conference on October 23-25, 2020 through Accelevents.
* Indicates required question
Email
*
Your email
Full Name (First and Last):
*
Your answer
High School Name, City and State (i.e. Pike High School, Indianapolis IN):
*
Your answer
Grade Level:
*
9th (Freshman)
10th (Sophomore)
11th (Junior)
12th (Senior)
Other
Which field are you interested in? (check all that apply)
Pediatrics
Family Medicine
Surgery
Anesthesia
Emergency Medicine
Radiology
Psychiatry
Neurology
I don't know yet
Other:
Are you interested in being paired up with a mentor?
Yes
No
Maybe
Clear selection
Are you interested in applying for a scholarship where your conference fee is paid for? (Limited Availability)
Yes
No
Maybe
Clear selection
(For those students applying for the scholarship) In 1-2 paragraphs, please tell us why you want to attend the conference?
Your answer
Submit
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