Registration

Hotel registration — By phone — By mail — By fax — By e-mail — Travel arrangement

By phone

To register by phone call toll free: 800-421-3756 or 303-798-9682 from 8 am-4:30 p.m. Monday through Friday (Mountain Standard Times, or for international caller GMT -7hours). Outside of business hours you can leave a voice mail message at the same numbers.

By mail

Please fill the form below and print it, then mail it to:

Medical Education Resources
1500 West Canal Court
Suite 500
Littleton, CO 80120-4569
USA

By fax

Please fill the form below and print it, then fax it to: 303-798-5731.

By e-mail

Please fill the form below and click on the Submit button.

Registration form

I know ! No one likes to fill forms, so we made it as short as possible. Please make sure that you have completed as many of the fields as possible. We are not using strict validation algorithms (this is too constraining I think), but the values that you will enter will be used for all your registration material, including the application for CME. Thus incomplete applications may cause you unnecessary aggravations.

Last name

First name

Middle Initial

Degree MD, PhD, DO, RDMS, RT, RN, other

Social security number (for US participant only, to register your CME credits)

e-mail address

Institution

Address

City

State (Province)

ZIP or Postal code

Country:

Daytime phone number (with area code and country code if outside the US)

Evening phone number (with area code and country code if outside the US)

Fax number

Please place me on your mailing list for information on future Prenatal Diagnosis of Congenital Malformation courses.

Please register me for the June 2000 course in Chicago

Please use the credit card # with expiration on for

course registration.

I would rather be billed for: course registration.

This is a registration from a

Comments?:

If you have troubles submitting this form with your browser, you can also highlight it, copy and send an email and past it in the body of the email.

To obtain further information please contact Mr. Steve Mattingly at steve@mer.org

Travel arrangement

Please contact Travel Counselors at 1-800-783-2702 or 303-797-6326 or by fax at 303-794-4650 and identify yourself as a partipant to the Prenatal Diagnosis of Congenital Anomalies course.