MITOC Circus Signup Form

CONTACT INFO:

Name
Email
Phone
Emergency Contact Phone

TRANSPORTATION:

I have a car I'm willing to drive. It holds people including the driver.
I'm 25 or older and I'm willing & able to drive a van rented by MITOC.
I need a ride. Will you please find me one?

Most people will go up Friday night and return Sunday night; you are welcome to stay later if you wish, or arrange other arrivals/departures as necessary. Make arrangements with lukesos@mit.edu if you have special travel needs.

MEDICAL:

Please list allergies or medical conditions you have:

Do you have medical training? No
Yes --  what level? 

Form created and maintained by Greg Galperin, grg@ai.mit.edu