Thank you for your interest in the PrairieMD program. This registration form is to collect a baseline set of information for administrative staff in the USask College of Medicine to begin planning your PrairieMD presentation. If you have any questions or concerns regarding the PrairieMD program, please contact the College of Medicine's Recruitment Coordinator, Davis Frerichs, at davis.frerichs@usask.ca

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* Contact Information

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* Year of Study

For the following questions, please provide details regarding the community you would prefer to visit, the time frame you expect to be able to visit there, and any curriculum elements that may line up with your community visit (e.g. electives, community experience, etc.). If you do not have a curriculum element to relate your community visit to, please provide details regarding your interest in visiting the community (i.e. if it is your home community, if you have interest in visiting the community for future learning opportunities or residency, etc.). For clarification of any details for this section, please contact the College of Medicine's Recruitment Coordinator, Davis Frerichs, at davis.frerichs@usask.ca

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* Community of Interest

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* Relevant Curriculum Elements

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* When is your preferred time frame (date/times) to schedule a PrairieMD school visit. Please enter a range of dates to select from or a re-occurring date/time that would work for your schedule.

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* Other comments

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