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IMANAHofstraRegistration

IMANAHofstraRegistration

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Published by Ayman Hossam Fadel

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Published by: Ayman Hossam Fadel on Jul 24, 2010
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10/25/2012

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 IMANA-Hofstra Ethics Symposium, Hempstead, NY,September 17-18, 2010
Registration Form
 
NOTE: Print clearly using only a black or blue pen.
Any field marked with an asterisk (*) is a required field.You may also register on-line athttp://bit.ly/REGISTER-IHE. For more information on the conference, visithttp://ethics2010.imana.org. Call IMANA at (630) 932-0000 with any questions. Name (as it appears in official identification) *: ___________________________________________________ Mailing Address*: __________________________________________________________________________ City*: _____________________ State/Province*: _________ Zip*: ________________ Country*: __________________ E-mail*: _____________________________________ Phone*: ____________________________________ Check the day or days you plan to attend in the row which best describes you, then calculate the net fees.
9/17 Price 9/18 Price
Speakers, Hofstra faculty and students, all medicalstudents
 
Free
IMANA Life Member Physicians
 
$50
 
$50IMANA Member Physicians
 
$75
 
$75Other Physicians
 
$100
 
$100 Non-Physicians
 
$25
 
$25Physicians in training (Fellows and Residents),Chaplains, other students
$25
Total fees
Discount 20% if Sent BeforeSeptember 1, 2010
- ____Net fees

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