hoja de registro - 2nd women's preventative care update
DESCRIPTION
Women's Health Society se complace en presentar el segundo Women's Preventative Care Update. Abajo a información de esta actividad con hasta 8 créditos AMA PRA Category 1 en educación continua para profesionales de la salud.TRANSCRIPT
Last NameFirst NameSpecialitySub-SpecialityLicense NumberMobile PhoneEmail Address WORKAddressCityStateZip CodePhone Number Fax Number All day pass $75.00$95.00$75.00 $95.00 REGISTRY OPTIONS AND FEES UNTIL NOV 7, 2015ON-SITE * REGISTRATION FEE INCLUDE Saturday BreakfastCoffee BreaksLunchCME Certificate PAYMENT METHODCHECKCheck NumberDateAmountMake Check Payable to:WOMENS HEALTH SOCIETYCREDIT CARDName on Credit Card (print as appears on card)CREDIT CARD AUTHORIZATION LETTER With this signature I authorize the use of my credit card described on this form for charges related to event registration.Authorization Signature DateCredit Card Number Security Number Expiration DateAmount POSTAL ADDRESSAddressCityStateZip CodePhone Number Fax NumberCONFERENCE REGISTRATION FORMSaturday, November 14, 2015 Puerto Rico Convention Center ADMINISTRATIVE USE ONLYDate Received SEND YOUR REGISTRATION TO:PMB 290 Calle Juan C Borbon #35 Guaynabo PR 00969Email:[email protected]: 787.789.4008Fax 787.294.6129 $75.00$95.00Ob GynMDOther ProfessionalsRegister online: http://whs2015.eventbrite.com