m1badge.bmp (67854 bytes) Meridian Chirurgeon Event Report Form s_fleam2.bmp (67854 bytes)

to be filed within Two (2) weeks post-event

 
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             Personal Copy          Kingdom Chirurgeon                       Autocrat                          Marshall 
Keep a copy for your records, send a copy to the Kingdom Chirurgeon, send a copy to the Autocrat, and a copy to the marshall in the event of a fighting related injury.
    C.I.C.   _____________________________  ________________________________
                                     SCA Name                            Legal Name
    Event    ______________________________________   Date ____/____/_______

    Location _____________________________  Host Group _____________________

    Autocrat _____________________________  ________________________________
                                     SCA Name                            Legal Name
    Marshall _____________________________  ________________________________
                                     SCA Name                            Legal Name
 
  

Estimated Site Census ___ Chirurgeon Census ___ Waterbearer Census ___
  Weather Conditions           Day                     Night
                         Hot / Cool / Cold        Hot / Cool / Cold
                            Wet / Dry                Wet / Dry
 
Total patient contacts for event
              Adult
Pediatric
Medical
   
Trauma
   
Ambulance Tx
   
Totals
   

 
Reproductions Permissible Copyright© 2000 Kingdom of Meridies, SCA