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Registration Form

Chief Resident Immersion Training Program (CRIT)
Salem Waterfront Hotel, Salem, Massachusetts

Saturday morning, June 2nd to Sunday afternoon, June 3rd 2012.

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


Responses are due by April 18th, 2012.

   *   Indicates required field
 
   * Full Name:
     Home Address:
     City:
     State:
     Zip:
     BMC Address:
   * E-mail Address:
     Pager #:
     Office Phone:
     Home / Cell Phone:
   * How many people (including yourself)
will be attending?
 
   * What type of room do you
prefer?
 
     Other comments regarding housing:
     Dietary restrictions:
   * What is your medical specialty
(subspecialty, if applicable)?
 
    *
   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: Cecilia Akuffo
88 E. Newton Street
Robinson 2700
Boston, MA 02118


Call: 617.638.6112
Fax: 617.638.8387
Email: Cecilia.Akuffo@bmc.org


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
    Yawkey Ambulatory Care Center
    3rd Floor
    850 Harrison Avenue
    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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