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18th Annual Hypertension, Diabetes and Dyslipidemia Conference (endorsed by American Society of Hypertension)

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18th Annual Hypertension, Diabetes and Dyslipidemia Conference (endorsed by American Society of Hypertension)

  1. 1. 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 Registration Form (FAX: TO 516-539-3555) 17th Annual Conference on Hypertension, Diabetes, and Dyslipidemia Charleston, South Carolina First Name: _______________________________ Last Name: _________________________________ Email: ____________________________________ Practice Name: ______________________________ Tel (Home/Cel): ____________________________ Tel (Office): __________________________________ Title (MD, DO,NP, PA, Other):___________________________ Address: _______________________________________________ City, St, Zip: _______________________________________________ Specialty: _____________________________ Years Practicing:__________ Patient Population (Gen/ Children/ Men/ Women/ Both/ Elderly, Etc):____________________________ How did you hear about us? __________________________________________ Fees: 17th Annual Conference on Hypertension, Diabetes and Dyslipidemia Only  $585.00 - Physicians  $525.00 - Residents and other healthcare professionals Combo (Hypertension Conference and 21 st Annual Primary Care Conference (Kiawah/ July 1-5)  $1145.00 - Physicians  $1000.00 - Others One Day Tuition (21 st Annual Primary Care Conference (Kiawah) $175.00-Physicians $150.00- Others # of Days________ PAYMENT METHOD: ___ CREDIT CARD (Visa/Mastercard): Card #__________________________________ Name on Card:_________________________________ Billing Address (If different):_________________________________________ _________________________________________ Expiration Date_________________ Security # (on back of card) ___________ ___ CHECK Mail: Continuing Education Company, Inc. Make Checks Payable to: 138 Palm Coast Pkwy NE, Suite 152 Continuing Education Company, Inc. Palm Coast, FL 321

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