Newsletter Request Form

Fields denoted by an asterisk (*) are required.

Name: Name: First Last
Preferred Distribution Date: Preferred Distribution Date: / MM / DD YYYY
Should the email be distributed to all preceptors in your region?:

Should the email be distributed to all preceptors in your region?: Yes No
Subject of the Newsletter (will appear in the subject line):
Type newsletter content here (or attach to this form):
Please upload any supporting text or images to this form:

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Questions about completing this form? Please email distributed.education@schulich.uwo.ca