Title:________________________________________________________________________________
Name:_______________________________________________________________________________
Address:_____________________________________________________________________________
City:_________________________________ State:____________________ Zip: __________________
Daytime Phone: __________________________________-____________________________________
E-mail Address:_______________________________________________________________________
Method of payment: ❑ Check/Money order (enclosed) or
❑ Please charge my: ❑ MasterCard ❑ Visa
Enrollment Fees: $ ____________________________________________________________________
(See fee schedule below)
Card No.:_________________________________________Security Code________________________
Signature: ________________________________________Exp. Date:___________________________
Select Conference Location
|
San Juan March 10-11, 2012 Telluride February 18-20, 2012 Telluride March 16-18 2012 Telluride March 19-21, 2012 |
Sports Medicine Conferences
Telluride
Physicians $895; Techs and Residents $395
$795
for VA/military/Canadian physicians
San Juan
Physicians $695; Techs and Residents $395
$595
for VA/military/Canadian physicians
17 hours CME category 1 AMA and
17 prescribed
AAFP CME hours
11 hours
ARST Category A
credits are available for the courses.
We do need 2 weeks notice prior to the course to obtain credit.
Register on-line at www.mskmr.com
or
Mail completed form and payment to: DW Renner • 3517 Brookwood Meadow• Cincinnati, Ohio 45208
Make checks payable to .
DW Renner
FAX CREDIT CARD REGISTRATIONS to (513) 751-2333 (USA)
ph: (513) 235-5215 • fax: (513) 751-2333 (USA)