2025 Winter Medical Conference, February 20-22,2025

Please fill out a separate form for each registrant

Registrant First Name *

Last Name *

Accompanying Person First Name (Spouse or Significant other)

Accompanying Person Last Name

Degree *

Your Specialty *

Your cell phone number in case we need to contact you *

Email address for your receipt *

$450 registration fee for physicians and dentists. $400.00 for nurses, residents/allied health professionals, guest attending meeting.

Please click one box only. *

Doctor Registration per person($450)

Nurses, residents/allied health professionals($400)

Retired doctors/nurse( $400) NO CE will be provided

Please RSVP for Thursday evening reception

Number of adults coming to the reception (up to 2 people included in one registration). If you are not coming, please enter 0. *

Number of children coming to the reception

In addition to the two people allowed by the registration, how many guests will you be bringing? If none, enter 0. *

Guest $100

Last day for refund will be Feb 1st,2025

Our payment are processed by PayPal. Once your form has been submitted you will be forwarded to PayPal where you will then enter in your payment information. YOU DO NOT NEED PAYPAL ACCOUNT. Credit Card payment will be taken. Unfortunately we are no longer able to accept payment by check.

Thank you very much!