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:




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
(414) 805-6034
(414) 805-5915 - Fax
moca-sim@mcw.edu

 

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