Simulation in Anesthesia for the Practicing Anesthesiologist Registration

MOCA® Simulation Course

UW Health Clinical Simulation Program

Madison, Wisconsin

Saturday March 07, 2020
8:00AM - 4:00PM

SPONSORED BY
University of Wisconsin School of Medicine and Public Health
Department of Anesthesiology
and UW Health Clinical Simulation Program

Registration Process
Fill out the registration form below. When you click 'Continue' you will have a chance to review the information before submission. Once you have verified the information and submited the registration, you will be given instructions for making payment (also included in a confirmation email). We currently cannot accept payments on-line, so you will either mail payment via check, or contact the Simulation Program office to arrange credit card payment.

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City State

Zip Country

EmailPhoneAlternate PhoneABA NumberYear of ABA CertificationBriefly describe your sub-specialty interest if applicable:Have you previously participated in a MOCA® simulation course, or another simulation course? If yes, what year and where?Special accommodation request (e.g., vegetarian diet, food allergies, physical needs, etc.):Scrub top size:

Scrub bottom size:

How did you hear about the course?

OtherDate of Class

Early registration (≥ 30 calendar days before course date): $1650
Late registration (< 30 calendar days before course date): $1750
Very late registration (≤ 7 days before course date): $1850
Total:

Click continue to verify your registration information.

For Further Information
Course information available here: Course Program
If you have immediate questions please contact Adam Weinstein, MD.

Registration Form
First Name Preferred First Name (Optional)
Last Name
Degree(s)
Position/Profession
Department
Institution/Organization
Type of Practice	(e.g., GI suite, pulmonary suite, radiology department, etc.)
Preferred Mailing Address