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Ellsworth County Medical Center Logo

Pre-Registration Form for CampMed

March 30, 2016

Currently, we have received pre-applications for our maximum number of CampMed attendees as well as numerous pre-registrations. We will not be accepting any more pre-registrations but sincerely hope that you'll be able to attend next year. Registrations are on a first come / first served basis.
Application & Payment should be mailed to:
Tisha Choitz, DON Administrative Assistant
Ellsworth County Medical Center
1604 Aylward Avenue
Ellsworth, Kansas 67439
* Student Name
* Mailing Address
* City/State/Zip
* Email
* Phone Number
* School District/Name of School
* Counselor’s Name
* Grade (must be Sophomore, Junior or Senior)
* Shirt Size