REGISTRATION FEE:    Enrollment for these courses is limited to about 12 surgeons.  Tuition includes educational materials,  videotapes, refreshment breaks, lunch on Day I and II. (A full breakfast is included in the room rate.)

$2,600.00 for surgeons who have completed a residency.

$1,600.00 for senior residents.

If you are repeating the course and paid the full tuition, please contact Dr. Rowland (603.359.0824) for reduced fee information.

 

Please note:  We have selected faculty based on their professional reputations.  We do not pay surgeons for participation in this course.


REGISTRATION DEADLINES: 

September 16, 2008 (for October 2008 offering)


LATE REGISTRATION FEE:  There is a $300 late fee charged for registrations made after deadlines.


CANCELLATIONS:  There is a $200.00 cancellation fee.          

 

TO REGISTER: 

CONFERENCE REGISTRATION FORM
Registration closes when course fills.
Early registration is encouraged.


CLINICAL PERFORMANCE & ORAL EXAMINATIONS IN SURGERY - 2007

Name _________________________________________ Degrees _________

Position __________________________ Affiliation ____________________

Mailing Address

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Home/Cell Tel.    ____________                                    Work Tel. ____________ 

E-mail Address (Required)


_____________________________@___________________________

List the course dates you will attend:
        

May or October 2008

 Circle the number of times you have taken
the Certifying Examination: 0 1 2 3 4 5 +


Have you ever completed a remedial year?

 _____ Yes _____ No


_____ Currently Enrolled


Please make check payable to:

 Medical Communications 

and return with this form to:
Ms. June Cameron
Dept. of Surgery
22 Bramhall Street
Maine Medical Center
Portland, Maine 04102

207-662-4078


If you wish to fax the form, the number is:

207-662-6389 FAX