8th Annual Primary Care Spring CME Conference:Session 1

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8th Annual Primary Care Spring CME Conference:Session 1

  1. 1. 8th ANNUAL PRIMARY CARE SPRING CONFERENCE At The Hammock Beach Resort in Palm Coast, Florida Registration Form (FAX: TO 516-539-3555) Please indicate which session you will be attending: □Session 1: □Session 2: March 31- April 4, 2014 April 14-18, 2014 STATE/PROVINCE: POSTAL CODE: FIRST NAME: LAST NAME: ATTENDEE’S EMAIL: ADMINISTRATOR'S EMAIL: PRACTICE/ORGANIZATION NAME: HOME PHONE: WORK PHONE: CELL PHONE: ADDRESS: CITY: COUNTRY: Specialty: Years Practicing: Patient Population: ___General (all ages/both genders) ___Adult Men & Women ___Children ___Adult Men __Young Adults/ Adolescents ___Adult Women ___Elderly ___Other___________ How did you hear about this conference: Do you practice in a rural area? TUITION: ___Yes ___No ___ $685.00 Physician ___ $585.00 Residents, NP, PA and other allied healthcare professionals PAYMENT METHOD: ___Credit Card (VISA or MASTERCARD ONLY) Card Number: Name on Card: Expiration Date: Billing Address (If different from above): Security # (on back of card): ___Check (Make payable to Continuing Education Company, Inc. Mail to: Continuing Education Company, Inc. 138 Palm Coast Pkwy NE, Suite 152 Palm Coast, FL 32137 CONTINUING EDUCATION COMPANY, INC. ● 138 PALM COAST PKWY, NE ● SUITE 152 ● PALM COAST, FL 32137 TEL: 800.327.4502 ● FAX: 516.539.3555 ● eMail: Walter@CMEmeeting.org ● Web: www.CMEmeeting.org A NON-PROFIT 501 (C)(3) ORGANIZATION

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