Calendar of Events - Courses


Please feel free to fill in and submit this on-line Course Request Form. A representative from MERIC will contact you in 1-2 business days to follow-up with your request.
* Denotes a Required Field
Organization:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Contact Person*:
Phone Number*
(area code first):
Fax Number
(area code first):
Email*:
Program Title:
Date(s) requested:
Alternate Date(s):
Time of Course:
Set-up time preferred:
Small description of course:
Number of Attendants:
Number of Support Personnel:
Which MERIC Faculty Staff Physician will you be working with?
What vendors will be supporting this course?
What audio/video needs are there?
Please briefly describe your anatomic procedure and in what ways the anatomic specimen will be utilized:
How many Anatomic Stations will you need?:
Will you bring instrumentation?
If yes, what will you bring?
Will you need radiology support?:
If yes, what type of support? (e.g. pre-program MRI, C-arm imaging, etc.):
Do you need catering for meals?
Would you like referrals for lodging, ground transportation, and/or resturants?





Copyright The Medical Education and Research Institute of Colorado
3920 N. Union Blvd. Suite 210 - Colorado Springs, Colorado - 80907 - tel: 719-548-8850 - meric@meric.info


 Privacy Policy & Legal Disclaimer