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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
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