Event Intake Form Question Title * 1. Full Name Question Title * 2. Cell Phone Question Title * 3. Email Question Title * 4. Your Town/City Question Title * 5. Your Province/State Question Title * 6. Emergency Contact Name Question Title * 7. Emergency Contact Cell Phone Question Title * 8. Do you have any dietary restrictions None Vegetarian Celiac Gluten Intolerance Lactose Intolerance Other (please specify) Question Title * 9. SMUC respectfully uses photos for marketing and training. If a photo of you is taken, may we use it? Yes No Question Title * 10. SMUC respectfully shares names/emails with our sponsor, Pendopharm, and the companies that generously provide the ultrasound machines that we use. May we share yours? Yes No Question Title * 11. Tell us about you! What is your current specialty/main practice type? Emergency/Urgent Care Family Medicine Naturopathic Physician Orthopaedic Surgeon Sport Medicine Other (please specify) Question Title * 12. Do you have access to an ultrasound machine? Yes, I own one Yes, I share one No, but I'm working on it Question Title * 13. If you have a machine: We provide all machines necessary for courses, but you are welcome to bring your own to practice with. Will you be bringing your own machine? No Yes (which machine are you bringing?) Question Title * 14. Select your Bootcamp level: Registered for Level 1 Registered for Level 2 Registered for Level 3 SMU Workshop Podiatry Next