Geriatrics Care at Boston Medical Center

Geriatrics

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Registration Form

Chief Resident Immersion Training (CRIT) Program
in the Care of Older Adults

Dates:  Friday evening, May 30 Sunday afternoon, June 1, 2014

Location:  The Cliff House Resort and Spa, Ogunquit, Maine

Didactic sessions occur in a conference center overlooking the Atlantic Ocean. During free time, participants can take advantage of many available activities.

Registration forms will be accepted on a rolling basis until Friday, April 11, 2014.

When you have completed the application form, click on the "Submit" button below, so your information will be forwarded to the Geriatrics section.

Once registered, you will receive additional information on the CRIT Program schedule. All registrants are expected to stay for the entire duration of the program.

CRIT Program attendees must provide their own transportation, which will be reimbursed by funds from the grants supporting the program. Details on reimbursement will be provided after your registration is complete.

   *   Indicates required field
 
   * Full Name:
     Title:
     Gender:     
     Home Address:
     City:
     State:
     Zip:
     BMC Address:
   * E-mail Address:
   * Pager #:
     Office Phone:
   * Home / Cell phone:
   * What is your medical speciality (subspeciality,
if applicable) or professional discipline?
   * How many people (including yourself) will
be attending?
 
   * If you plan to come alone, would you be
willing to share a room with another participant?
 
     Other comments regarding accommodation:
Note: To request reasonable accommodation for a disability,
please notify Amy Alawad (aalawad@bu.edu), in writing,
at least two weeks prior to the conference.
 
     Dietary restrictions:
     Additional questions/concerns:
 
  
   THE INTERNET IS NOT SECURE ─ WE HIGHLY RECOMMEND AND ADVISE YOU NOT TO PROVIDE ANY CONFIDENTIAL OR SENSITIVE INFORMATION OVER THE INTERNET. IF YOU CHOOSE TO DO SO, IT IS AT YOUR OWN RISK. ANY UNLAWFUL OR CRIMANAL CONTENT PROVIDED, WILL BE SUBJECT TO LAW ENFORCEMENT REVIEW.
 
 
 

For additional information, please contact:

Boston Medical Center
Geriatrics Section
ATTN: Amy Alawad, MSPH, MPA
88 E. Newton Street
Robinson 2700
Boston, MA 02118


Call: 617.638.6112
Fax: 617.638.8387
Email: aalawad@bu.edu


NOTE: The CRIT Program in Geriatrics is co-funded by grants from The Hearst Foundations and The Donald W. Reynolds Foundation.


Errors With Submission:

Appointments

Call: 617.414.4639
Fax: 617.414.4094


Boston Medical Center
Geriatrics Clinic
Shapiro Center
725 Albany Street
9th Floor, Suite 9A
Boston, MA 02118


Refer a Patient

Call: 617.414.4639
Fax: 617.414.4094


Home Care & Nursing Home Program Referrals & Information

Call: 617.638.6100
Fax: 617.638.6179


Administration Office

Boston Medical Center
Section of Geriatrics
88 East Newton Street
Robinson 2
Boston, MA 02118-2393
Call: 617.638.8383
Fax: 617.638.8387


Education Program

Call: 617. 638.6112
Fax: 617.638.6152


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