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Step 1: MedWAR Utah Registration Form
*Indicates Required Field

Team Name*:

Affiliation: (School/Hospital/Organization)
Hometown: (City, State/Providence)

Team GPS unit

Team Captain

First Name*: Last Name*: Occupation: (Physician/EMT/WFR/Student/etc.)
Email*:

Street Address*:
City*: State/Province*:
Country*: If other, Country:
Zipcode*:
Phone Number:

Height: Weight: Ski Boot Size:

Snowshoes

Special Food Needs*




(*We will attempt to accommodate, but consider bringing back-up.)

Team Member 2

First Name*: Last Name*: Occupation: (Physician/EMT/WFR/Student/etc.)
Email*:

Height: Weight: Ski Boot Size:

Snowshoes

Special Food Needs*




(*We will attempt to accommodate, but consider bringing back-up.)

Team Member 3

First Name*: Last Name*: Occupation: (Physician/EMT/WFR/Student/etc.)
Email*:

Height: Weight: Ski Boot Size:

Snowshoes

Special Food Needs*




(*We will attempt to accommodate, but consider bringing back-up.)

How did you hear about MedWAR?




(Google, etc.)

Questions/Comments

 

   
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Because there's more to survival than being the fittest...