Vasculitis: Current Concepts and Best Practices - Rare Disease

Registration
Fees: Standard Late and On Site
Received by Received after
July 1, 2010 July 1, 2010
Physicians $100 $125
Allied Healthcare Professionals $75 $85
*Residents/Fellows $40 $55
*Residents/Fellows registration must include written proof of residency (a letter from Program Director) to receive reduced fee.
Residents/Fellows must send the registration form and written proof via mail or fax.
CME credit, course materials and continental breakfast are included with the registration fee.
FOUR METHODS FOR REGISTERING
� Mail registration form and payment
(checks made payable to Cedars-Sinai
Medical Center) to:
Cedars-Sinai Medical Center
Office of Continuing Medical Education
Attn: Registration
8797 Beverly Boulevard, Suite #250
Los Angeles, CA 90048
8 Register online at www.csmc.edu/cme
and click on CME Courses
7 Fax completed registration form with credit card
payment information to (310) 423-0309.
' Call (310) 423-5548 to register with a credit card.
Registration Form
Please Print Clearly
CONFIRMATION:
In order to receive a registration confirmation, please
provide your e-mail address or fax number. If you do
not receive a confirmation, please call 310-423-5548 to
confirm your registration.
REFUND POLICY:
All cancellations must be submitted in writing and refunds
will be subject to a $25 administrative charge. No refunds
will be given after Friday, July 23, 2010.
�We encourage participation by all individuals. If you
have a disability, advance notification of any special needs
will help us better serve you.
Last Name: ____________________________________ First Name: ___________________________________________________________
Address: _____________________________________________________________________________________________________________
City: ________________________________________________________ State: _______ Zip: ______________________________________
Phone: ( ) ______________________ Fax: ( ) ______________________ E-mail: ________________________________________
Specialty/Area of Interest: ____________________________________ Degree: £ MD £ DO £ RN £ PA Other _______________
Payment Method:
For further information call 310-423-5548
or visit www.csmc.edu/cme
Vasculitis: Current Concepts and Best Practices Saturday, July 31, 2010
£ Check (payable to CSMC) Amount: $ _________________ £ Credit Card: £ Visa £ MasterCard £ American Express
Credit Card Number: ____________________________________________________ Exp. Date: ________ Amount: $ ____________
Name on Card: __________________________________________________________________________________________________
Authorized Signature: _____________________________________________________________________________________________