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304.293.3631

its@hsc.wvu.edu

P.O. Box 9010

Morgantown, WV 26506

 

MDTV Program Registration Form


This form is for registation of MDTV Events only.
PLEASE NOTE: Registrations must be made no less than 24 hours in advance in order to guarantee participation.


* Required

*Name:
*E-mail:
Site/Department:

Registration Request:

Desired Program (select all that apply): Click here for detailed program information.
Yes No Medicine Grand Rounds
(Every Friday 8a - 9a) 		Date(s):
Yes No Surgery Grand Rounds
(Every Wednesday, 8a - 9a) 		Date(s):
Yes No Surgery CP
(Every Wednesday, 9a - 10a) 		Date(s):
Yes No Pediatric Grand Rounds
(Every Wednesday, 8a - 9a) 		Date(s):
Yes No Emergency
(Every Thursday, 8a - 9a, Last Thur. of month 9-10am) 		Date(s):
Yes No  

Other Event

 

 Date(s):

Time(s):

Event Name:

* Please check yout e-mail carefully to verify your registration. It is the responsibility of the requestor to know which programs are confirmed.

Change Existing Registration

Change: Yes No
Original Date:
New Date:
Original Time:
New Time:
Original Event:
New Event:

Additional Comments and Information:


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