Application Form

Open Course Dates

* Required

* Course Name / Date:

Prefix: Mr Ms

* First Name:

* Last Name:

Discipline: Physician Nurse Other:

Specialties:

Title:

* E-Mail Address:

* Institution Name:

* Institution Address 1:

Institution Address 2:

* City:

* State:

* Zip Code:

* Country:

* Telephone Number:

Please enter any other information you feel would help us in
setting up your Course;

IMS COURSE FEES:
Comprehensive Instructor Course: USD $4,425
Simulation as a Teaching Tool: Price varies by Host Site
Training Webinar, 4 1/2 Hours: USD $350
Graduate Courses including 1webinar and 4 days at CMS: USD $4,425

PAYMENT:
Tuition is due immediately after you have received your acceptance email. Payment details are provided below.

The Center for Medical Simulation accepts payments by credit card, money order or check.
To pay by credit card, please contact Rhonda Young at reyoung@partners.org.
Payment by money order or check should be made out to "Center for Medical Simulation" and sent to:

Center for Medical Simulation
100 First Avenue
4th Floor - Suite 400
Boston, MA 02129
Attn: Gary Rossi, C.O.O.

Enrollment and cancellation policy:
You will be informed of your acceptance to the selected course above by email. Please reconfirm your intention to attend by replying to the acceptance email.

Tuition is due immediately after receiving acceptance. When a class fills up, we start a waiting list. If you must cancel and another candidate can fill your seat, we will refund your tuition, less $250 for administration and processing. If we cannot fill your seat, you will forfeit half your tuition and we will refund the remaining half.