Abdominal Aortic Aneurysm Repair- Surgical Demonstration with Dr. Mike Williams, MD
Fill out the form carefully for registration. If you have any questions please reach out to Laura Jenkins at laura.jenkins.1@health.slu.edu
School Name:
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Teacher Name
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First Name
Last Name
Address
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Street Address
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Postal / Zip Code
Teacher Email
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example@example.com
Teacher Phone Number
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Format: (000) 000-0000.
Grades of Students in Attendance
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Total Number of Students
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Hands-On Programming Following (Please note that these are capped at a certain number, once we reach capacity you will no longer see that option available):
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Pig Heart Dissection (10:45-11:45)
Cadaver Demonstration (10:45-11:45) Please note that space is limited on 4/13
Cadaver Demonstration (12:00-1:00) Please note that this time slot is full on 4/13
None- we do not wish to attend any programming following Dr. William's talk
Date Attending:
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Tuesday November 18th, 2025
Monday April 13th, 2026
Do you plan to use the dining hall for your students?
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Yes
No
Have you attended an AIMS Auditorium Program before?
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Yes
No
If this is your first time with us, how did you hear about us?
PAYMENT POLICY :I understand by submitting this registration that I will be invoiced for 80% of the total cost, which is due upon receipt. For any remainder due, you will be billed separately following completion of your program. If 80% is not received by 30 days prior to your program, you will be responsible for 100% of the students you register for. No refund will be provided for amounts less than 80% of your initial total student registration. Cancellations 30 days or more before the scheduled program will receive a full refund. Cancellations within 30 days will received a refund, less a $100 nonrefundable deposit.
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Yes, I acknowledge that I have read and understand the payment and cancellation policy above.
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