Dawn of a New Day Mass Casualty Tabletop Exercise 19A- Dayton Children's Night Shift

Please complete the information below to sign up for the exercise.

The exercise will be held at Dayton Children's Hospital (main campus), on Wednesday, August 14th, 2019, from 4:00 PM to 9:00 PM and will include a working dinner.

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* 1. First Name:

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* 2. Last Name:

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* 3. Please select your hospital or agency:

Atrium Medical Center

Dayton Children's Hospital

Dayton Children's Hospital - South

Dayton Department of Veteran Affairs

Grandview Medical Center

Greene Memorial Hospital

Soin Medical Center

Miami Valley Hospital

Miami Valley Hospital - North

Miami Valley Hospital - South

Southview Medical Center

Springfield Regional Medical Center

Sycamore Medical Center

Upper Valley Medical Center

Wayne Healthcare

Wilson Health

Wright Patterson Medical Center

EMS, EMA, Law Enforcement, other Hospitals, or other Agencies:

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* 4. Your Position

Physician

Nurse

Administrator

Law Enforcement Officer

Paramedic

EMT

Physician's Assistant

Other (please specify)

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* 5. Your E-mail address:

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* 6. Please carefully confirm your e-mail address from above. This is how we will send directions to the exercise, any changes, and exercise materials.

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* 1. First Name:

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* 2. Last Name:

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* 3. Please select your hospital or agency:

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* 4. Your Position

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* 5. Your E-mail address:

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* 6. Please carefully confirm your e-mail address from above. This is how we will send directions to the exercise, any changes, and exercise materials.

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* 7. Though we cannot guarantee to honor requests, please let us know if you have dietary restrictions (e.g., gluten-free, vegetarian, etc.).