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COURSE
REGISTRATION-
Print out this page and fill out form and following mailing
insturctions at bottom of page.
"Injection
Snoreplasty — A Workshop"
Fee:
$250.00 / (No charge to Military Physicians) Advanced registration is mandatory.
Please
check one:
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Chicago,
IL
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Saturday, October 27,
2001
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8:30 am — 12:30
pm
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Registration must be received
by October 1, 2001
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New York,
NY
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Saturday, November 10,
2001
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8:30 am — 12:30
pm
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Registration must be received
by October 15, 2001
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Washington,
DC
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Saturday, December 8,
2001
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8:30 am — 12:30
pm
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Registration must be received
by November 10, 2001
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Dallas,
TX
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Saturday, January 12,
2002
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8:30 am — 12:30
pm
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Registration must be received
by December 15, 2001
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Orlando,
FL
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Saturday, February 9,
2002
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8:30 am — 12:30
pm
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Registration must be received
by January 15, 2002
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Los Angeles,
CA
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Saturday, March 9, 2002
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8:30 am — 12:30
pm
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Registration must be received
by February 15, 2002
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Please
Print:
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Name:
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Address:
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City:
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State:
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Zip:
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Phone:
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Fax:
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Social
Security # (for CMEs):
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Yes
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No
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I will be staying at
the hotel on the nights of:
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Please indicate whether
a stay at the hotel is needed. When making your own hotel reservation please mention
the Injection Snoreplasty Workshop sponsored by SNAP Laboratories and a discounted
rate will be granted.
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METHOD OF PAYMENT
Fee is $250.00
(No charge to Military Physicians). Please make check payable to SNAP Laboratories.
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Enclosed, please find my check in the amount of $_________
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Please charge $_________ to Visa or Mastercard (circle one)
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Printed Name:
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Signature:
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Acct #:
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Exp Date: |
ALL
REFUNDS MUST BE IN WRITING AND RECEIVED 3 WEEKS PRIOR TO THE
COURSE DATE. AFTER THIS DATE, NO REFUNDS ARE POSSIBLE.
Please
mail or fax registration & payment detail to:
SNAP
Laboratories
Re: Injection Snoreplasty Workshop
3633 West Lake Ave #406
Glenview, IL 60025
Ph# 800.762.7786 ext. 201 / Fax# 847.657.8586
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