Exit Midwest Chapter of SCCM Jeopardy application Question Title * 1. Institution Question Title * 2. Participants’s Sub-Speciality Pediatric Critical Care Adult Critical Care Other (please specify) Question Title * 3. First Participant’s name? Question Title * 4. First Participant’s Year in Training PGY-1 PGY-2 PGY-3 PGY-4 PGY-5 PGY-6 PGY-7 Other (please specify) Question Title * 5. Second participant’s name? (On your team) Question Title * 6. Second participant’s year of training PGY-1 PGY-2 PGY-3 PGY-4 PGY-5 PGY-6 PGY-7 Other (please specify) Question Title * 7. Are you a SCCM Member? Yes No Question Title * 8. Are you Midwest Chapter member? Yes No Question Title * 9. How did you hear about this event? Question Title * 10. At what email address would you like to be contacted? Done