2021 NM Judge Form

Poster Judge

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* 1. I would like to participate in the following:

I would like to judge posters (posters will be presented on Nov. 6th at UNM)

I would like to judge oral clinical vignette (OCV will be presented on Nov. 6th at UNM)

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* 2. Name:

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* 3. Credentials (please check all that apply):

MD

DO

MBBS

FACP

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* 4. ACP Membership Category:

Master, Fellow, Member

NonMember

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* 5. Cell phone (to be only in emergency):

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* 6. Email Address:

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* 7. Institution: