Suture Workshop Group Sign Up: Buy 5 Get $15 Off Each

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Which suture workshop would you like to sign up for?*

SOLD OUT March 15, 17, 19 & 22-- 7:00 pm ET
April 13, 15, 20 & 22-- 8pm ET
May 10 - 21, 2021 -- TBC
June 14 - 25, 2021 -- TBC

Intern 1

First & Last name*

Phone number*

Email address*

Mailing address*

Street Address Address Line 2 City State ZIP Code

Note: The suture kit will be sent to your name to this mailing address. To U.S. addresses of the 48 contiguous states. Outside of that area, may require additional shipping time. Outside the US will require an additional shipping cost.

Intern 2

First & Last name*

Phone number*

Email address*

Mailing address*

Street Address Address Line 2 City State ZIP Code

Note: The suture kit will be sent to your name to this mailing address. To U.S. addresses of the 48 contiguous states. Outside of that area, may require additional shipping time. Outside the US will require an additional shipping cost.

Intern 3

First & Last name*

Phone number*

Email address*

Mailing address*

Street Address Address Line 2 City State ZIP Code

Note: The suture kit will be sent to your name to this mailing address. To U.S. addresses of the 48 contiguous states. Outside of that area, may require additional shipping time. Outside the US will require an additional shipping cost.

Intern 4

First & Last name*

Phone number*

Email address*

Mailing address*

Street Address Address Line 2 City State ZIP Code

Note: The suture kit will be sent to your name to this mailing address. To U.S. addresses of the 48 contiguous states. Outside of that area, may require additional shipping time. Outside the US will require an additional shipping cost.

Intern 5

First & Last name*

Phone number*

Email address*

Mailing address*

Street Address Address Line 2 City State ZIP Code

Note: The suture kit will be sent to your name to this mailing address. To U.S. addresses of the 48 contiguous states. Outside of that area, may require additional shipping time. Outside the US will require an additional shipping cost.

Other Information

University(ies)*

How did you find out about the VAW Global TeleHealth Program?*

Facebook / Instagram
WhatsApp or GroupMe text
Phone text
Google Search
VAW Chapter Team Leader / TDC
Other (please elaborate below)

Other

If you answered "other" to the prior question, please elaborate.

Who referred you to the VAW Global TeleHealth Program (if applicable)?*

Please note their full name, including first and last name, and university, if applicable.

Terms and Conditions*

We have read and agree to the TeleHealth Terms and Conditions of VAW Global Health Alliances.

Suture Workshop Group Sign-Up

Payment Method*

Suture Workshop Group Sign Up: Buy 5 Get $15 Off Each

General information

Proposed deposit schedule

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Intern 1

Intern 2

Intern 3

Intern 4

Intern 5

Other Information

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