EmailMeForm
PAN Medical Student Group Registration
Thank you for your interest in creating a new PAN USA-affiliated group at your medical school. Please complete this form and you will be contacted shortly. Email Megan Fischer at info@pan-usa.org with any questions and for assistance.
Your Name
*
First
Last
Your Medical School
*
City
State
Your Status
*
Student
Instructor
Other
Your Email
*
I want to receive PAN USA's e-newsletter.
Your Phone
###
-
###
-
####
How do you prefer to be contacted? (check all that apply)
Email
Phone call
Text
Tell us anything you think we should know about you and your ideas for this PAN USA student group.
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