Lil’ Scrubs Club Form Name(Required) First Last Email(Required) Please Select One(Required) Physician Trainee Coordinator / Administrator Research / Academic Non-physician health professional Education Scientist Other Please indicate belowAre you formally registered to attend ASE or SEW 2026?(Required) Yes No Will this be your first time attending the ASE annual meeting?(Required) Yes No Number of children that you would utilize this for?(Required) 1 2 3 4 5 Age Ranges of Children(Required) 6 – 12 Months 1-3 Years 4-6 Years 7-8 Years What days would you utilize daycare?(Required) Tuesday, April 28th Wednesday, April 29th Unsure at this time Please select all that applyWhat times ranges would you utilize it on Tuesday?(Required) 6:30AM – 10:30AM 10:30AM – 1:30PM 1:30PM – 4:30PM 4:00PM – 8:00PM Please select all that applyWhat times ranges would you utilize it on Wednesday?(Required) 7:00AM – 11:00AM 11:00AM – 2:00PM 2:00PM – 6:00PM 6:00PM – 9:30PM Please select all that applyAdditional notes or comments
