Online Brochure | Print Version
Please complete registration form by, Nov. 28, 2008
General Information
Last Name First Name Middle Initial Degree Street Address City State Zip (Zip format:12345-1234)
Home Work Day Phone ( )
E-mail
License # (Required for credit)
Profession (Please check)
Physician ($175) (Specialty)
Other ($120) (Specify)
$10 discount on above registration (if submitted by Nov. 28)
KU School of Medicine Resident Physician [with pre registration, no charge] Medical Student [with pre registration, no charge]
Using the program printed in this brochure, please select a first and second choice for each set of concurrent sessions. Assignments will be made as registrations are received. Every possible effort will be made to honor first-choice requests.
*Session #13 - Limited participation.
I do I do not plan to attend the Friday luncheon
I prefer a vegetarian meal
Will send payment via mail Make check payable to: "KUSM-W Div. of Postgraduate Ed." Mailing address: Postgraduate Education KU School of Medicine-Wichita 1010 N. Kansas, Wichita, KS 67214-3199
Will pay via phone, 316-293-2636 Will pay via fax, 316-293-1851
