OHIO ACP DOCTOR’S DILEMMA 2018 REGISTRATION Please complete the following fields to register your team for Doctor’s Dilemma. Mail form to Jan Wrassman at Residents Dilemma Doctor’s TEAM NAME: MEDICAL SCHOOL or RESIDENCY PROGRAM: PRIMARY CONTACT PERSON FOR THE TEAM: EMAIL: TEAM MEMBER 1 NAME: ACP NUMBER: (enter if not yet available pending TEAM MEMBER 2: NAME: ACP NUMBER: (enter if not yet available pending TEAM MEMBER 3: NAME: ACP NUMBER: (enter if not yet available pending ALTERNATE MEMBER: NAME: ACP NUMBER: (enter if not yet available pending
OHIO ACP DOCTOR’S DILEMMA 2018 REGISTRATION Please complete the following fields to register your team for Doctor’s Dilemma. Mail form to Jan Wrassman at Residents Doctor’s Dilemma TEAM NAME: MEDICAL SCHOOL or RESIDENCY PROGRAM: PRIMARY CONTACT PERSON FOR THE TEAM: EMAIL: TEAM MEMBER 1 NAME: ACP NUMBER: (enter pending if not yet available TEAM MEMBER 2: NAME: ACP NUMBER: (enter pending if not yet available TEAM MEMBER 3: NAME: ACP NUMBER: (enter pending if not yet available ALTERNATE MEMBER: NAME: ACP NUMBER: (enter pending if not yet available
18_doctors_dilemma_registration_form.docx