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Leader Visit Request Form

Important

This form must be completed at the time of the request.  For rotation leader visits, Chapter Services budgets one hotel night for the leader. Should the chapter exceed the number of nights allowed, they are resposible for the remaining nights & expenses. 

*Required

Visit Information

Request Primary and Alternate Leaders  (do not select the same leader more than once)

Meeting Information

Hotel Location

Meeting Location

Specific Presentation(s) Requested

Presentation #1(Required)

Presentation #2

Physicians

Nurses

Residents

PAs

EMTs

Chapter Contact Information

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