Trainee Registration - 2025 Northwestern Phaco Training Course | Sept 27
Trainee Registration - 2025 Northwestern Phaco Training Course | Sept 27
Name
Name
*
First
Last
Email address
*
Phone
Phone
-
###
-
###
####
Email Address of Program Coordinator
*
Please select your institution
Case Western Reserve University
RUSH University
Cook County Health Ophthalmology
Northwestern University
Cook County Health
University of Chicago
University of Illinois Chicago
Case Western
Indiana University
Loyola University Chicago
If not listed above, please list your institution
Please select which PGY you will be by the time of the event
*
Please select which PGY you will be by the time of the event
PGY-2
PGY-3
PGY-4
Will you be requiring a vegetarian option for dining?
Will you be requiring a vegetarian option for dining?
Yes
No