Nephrology - CME
Nephrology - CME
Nephrology - CME
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April 15-20, 2007 The Westin Copley Place ~ Boston, Massachusetts<br />
NEPHROLOGY<br />
2 0 0 7<br />
Registration Form PLEASE PRINT CLEARLY<br />
FULL NAME: LAST FIRST MIDDLE INITIAL<br />
DEGREE<br />
MAILING ADDRESS: STREET<br />
CITY STATE ZIP CODE<br />
COUNTRY<br />
E-MAIL ADDRESS<br />
Please check if you wish to be excluded from receiving e-mail notices of future Harvard Medical School<br />
Department of Continuing Education programs.<br />
DAYTIME PHONE FAX NUMBER<br />
PROFESSIONAL SCHOOL ATTENDED YEAR OF GRADUATION<br />
PROFESSION<br />
PRINCIPAL SPECIALTY BOARD CERTIFIED: YES NO<br />
ORGANIZATION AFFILIATION COURSE #272938<br />
Form of Payment<br />
Please check one:<br />
Registration Fees:<br />
Tuition fee: $1289 (U.S.D.)<br />
Reduced fee for Residents* and Fellows in Training*: $900 (U.S.D.)<br />
*A letter of verification from Department Chair must accompany application for a reduced fee.<br />
CHECK IS ENCLOSED. Please make your check payable to Harvard Medical School and mail it with this<br />
registration form to: Harvard Medical School Department of Continuing Education, P.O. Box 825, Boston, MA 02117-0825<br />
BILL MY CREDIT CARD: VISA MASTERCARD<br />
CREDIT CARD NUMBER: - - - TUITION FEE: $<br />
EXPIRATION DATE: / SIGNATURE<br />
NAME AS IT APPEARS ON CARD<br />
Registrations paid by credit card may be registered online at www.cme.hms.harvard.edu, faxed to 617-384-8686, or mailed to<br />
Harvard Medical School Department of Continuing Education, P.O. Box 825, Boston, MA 02117-0825.<br />
Online registrants - add the first three characters of the source code found<br />
here. →<br />
Source Code: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z