MCW MOCA® Simulation Course Registration

*Required

*First Name


*Last Name

 

*Company/Institutional Affiliation:


*Degree:
 MD       PhD        DO

*Address 1:


Address 2:


*City:


*State:


*Zip


*Email:


*Work Phone:


Fax Number:

*ABA Number:

ASA Number:  (if you have one)

*Course Date:

March 26, 2016 (Full)   September 17, 2016   November 5, 2016


Registration Fee (includes simulation course, supplemental materials, breakfast, lunch, and CME fees)
Payment must be received to reserve spot at the simulation course

 Non MCW - $1,500.00    MCW Faculty or Alumni - $1,300.00 
                                              *Alumni - Please state year of graduation from residency
 

Method of Payment
*Please download the appropriate MOCA® Registration Form (PDF) to provide detailed payment information.  This form will appear after selecting the "Submit" button below.

Check (make payable to Medical College of Wisconsin, Department of Anesthesiology)
      *There is a $25 returned check fee
Credit Card (Visa or Mastercard)
MCW Anesthesia Faculty only: Take fee from Education Account

*Please note that for immediate reservation, a credit card or education funds must be used.  There is a delay in reservation until a check payment is received in the mail.

Cancellation Policy

  • Cancellation more than 30 days prior to the course – full refund (minus $150 administrative fee). There will be no refund for cancellation within 30 days of the course.
  • In order to avoid the cancellation fee, participants may elect to name a substitute to attend in his/her place.
  • We reserve the right to cancel any simulation course, which does not have a minimum of 3 confirmed participants. Enrolled participants will be notified at least 4 weeks prior to the scheduled course, if it is cancelled.

 

For additional information, contact:

Kristina Maynard
Department of Anesthesiology-Education Division
Medical College of Wisconsin
9200 W. Wisconsin Ave; P347
Milwaukee, WI 53226
Phone: (414) 805-5916
Fax: (414) 805-5915
moca-sim@mcw.edu

 

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
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Page Updated 05/02/2016
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