WashU Medicine Reception during the American College of Emergency Physicians (ACEP) Scientific Assembly

You’re invited to join Opeolu Adeoye, MD, head of the department of emergency medicine, and fellow WashU Medicine alumni for a reception during the American College of Emergency Physicians (ACEP) Scientific Assembly.

Tuesday, October 6
5-7 p.m.
Marriot Marquis Chicago – Ballroom, 2121 S. Prairie Ave., Chicago, IL 60616

Enjoy complimentary appetizers and drinks and connect with former colleagues and friends during ACEP.

RSVP

Yes, I will attend.
No, I will not attend.

Attendance Method

In Person
Virtual

*First Name

*Last Name

Phone

Phone Type

*Email

*Number of people attending, including yourself

Please Note: University Advancement will use details entered here as your preferred contact information for future communication from the University.

We strive to host inclusive, accessible events that enable all members of our community to engage fully. To request an accommodation or for inquiries about accessibility, please contact our alumni office at medicaladvancement@wustl.edu.

Other - Please describe.

1st Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Close to the Door
Escort Required
Must have a Chair
No Stairs
Nursing Mother Room
Prayer Space
Ride Requested
Special Parking Arrangement Required
Support/Service Animal
Wheelchair Access
Wheelchair Requested
None
Other

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

2nd Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

3rd Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

4th Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

5th Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

6th Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

7th Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

8th Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

9th Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

10th Attendee

*First Name

Preferred First Name

*Last Name

Relationship to WashU

WashU Alumni
Current WashU Student
WashU Parent
WashU Faculty
WashU Friend
WashU Staff
None

Guest Age Group

Adult
Child (13-17)
Child (6-12)
Child (5 and under)

Size (Swag)

XS
S
M
L
XL
2X
3X
4X

Do you have any of the following dietary preferences or requirements?

Gluten Free
Halal
Kosher
No Dairy
No Pork
No Red Meat
No Shellfish
Nut Allergies
Pescatarian
Vegan
Vegetarian
None
Other

Please list your other dietary preference.

Do you have any of the following accessibility preferences?

Please list your other accessibility preference.

Please list your other presentation preference.

Please list any other preferences.

*What is your relationship to WashU Medicine?

MD Alumni
Emergency Medicine Residency or Fellowship Alumni
WashU Medicine Faculty
Other

What is your MD Class Year?

What year did you complete your training at WashU Medicine?

If other, please describe:

Please list any dietary restrictions or allergies.

Would you like to make a donation?

Yes
No

Total

$ 0

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