CaRMS Volunteer Registration Form
Personal Information
First Name:
Last Name:
E-mail:
Phone Number:
(For Emergencies)
Address:
City:
Province:
Postal Code:
Location:
-------- Select One --------
McMaster Family Practice
Stonechurch Family Health Centre
Brampton
Kitchener/Waterloo
Rural
Community Based Residency Training
Niagara
Other
Position:
---- Select One ----
Resident
Faculty
Volunteering Information
# of Days to Volunteer:
----
1
2
3
4
5
Dates Available:
(Check all that apply)
Friday, January 22, 2010
- IMG
Saturday, January 23, 2010
- Urban
Sunday, January 24, 2010
- Rural and KW
Friday, January 29, 2010
- Urban
Saturday, January 30, 2010
- Brampton and Niagara
Task:
Interview Applicant
Score Applicant Letter (Faculty Only)
Comments:
(Optional)
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