Application - Apprentice Doctor

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* First name

* Last name

* Email address (student)

* Mobile phone (student)

* Age

* Gender

* Email address (parent/guardian)

* Mobile phone (parent/guardian)

* Street address:

Suburb:

* City:

* State / Province / Region:

* ZIP / Postal Code:

* Country:

* Program

* Scrubs Size

* Dietary Preference

* What will be your academic level at the time of the event?

The following school section is only for Grade 12 or younger

School name:

School's email address:

School's phone number

Contact person at school:

Medical information (if applicable):

Why do you want to attend this event?

If your parents recommended it, what did they say were their reasons for thinking you should attend?

* Write an application letter to Dr. Anton Scheepers:

Give reasons why you would like to pursue a career in medicine. Add academic and general information about your journey so far.

* Confirmation: I am strongly considering a career in medicine/healthcare! * Confirmation: I match the eligibility criteria for this event (see Event Information above). * Confirmation: I am aware that this event has a fee, payable on acceptance of my application.