How did you learn about the seminar? ____Brochure
____E-mail ____Personal Contact ____
Website
______ Field
Traumatology, March 11-12, 2010 (15 CEUs)
Registration: 7:45 a.m. Seminar: 8:00 a.m. - 5:00 p.m.
(Lunch on your own)
Cost: $250. Course fee is discounted to $199
($175 for students) if registration is received on or by February
26th.
Refund and Cancellation Policy:
A minimum number of
participants must be registered before February 26th or the workshop will be
cancelled on that date. There will be no refund unless the workshop
is cancelled and only those registered by that date will be exempt
from this policy.
Payment method: ______ check
______ credit card (Payable in US dollars)
Charge to: _____ MasterCard
_____ Visa Amount: $___________
Card # ________________________________ Expiration date:
_______/_______
Name on
card:_______________________________________________________
Cardholder
signature:_________________________________________________
Fax with
credit card information to 405-691-0452 or mail
form
with check made payable to:
Oklahoma Traumatology Institute
3037 N.W.
63rd St., Suite 150
Oklahoma
City, OK 73116
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