18E 2023 Soin Medical Center and Greene Memorial Hospital FSE Moulage Artist Sign-Ups

On Sunday, April 30th from 10:00AM-4:00 PM, Dayton MMRS will put on a mass casualty exercise hosted by Soin Medical Center and Greene Memorial Hospital. We are looking for people to assist with victim moulage for this exercise. If you are interested, please fill out the information below. Thank you.

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* Moulager
Last Name:

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* First Name:

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* E-Mail:

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* Confirm E-Mail (Very Important: you will receive all information about the exercise via email.):

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* Phone Number:

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* Where would you be able to serve as a Moulage Artist?
(Select all that apply)

Clark State Community College – Greene Center (3775 Pentagon Blvd., Beavercreek)

Greene Memorial Hospital

No preference

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* MoulagerLast Name:

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* First Name:

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* E-Mail:

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* Confirm E-Mail (Very Important: you will receive all information about the exercise via email.):

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* Phone Number:

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* Where would you be able to serve as a Moulage Artist?(Select all that apply)

* Moulager
Last Name:

* Where would you be able to serve as a Moulage Artist?
(Select all that apply)