Urban Cardiology - Division of Cardiology - Wayne State University
Urban Cardiology - Division of Cardiology - Wayne State University
Urban Cardiology - Division of Cardiology - Wayne State University
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SECOND ANNUAL URBAN CARDIOLOGY Reducing Disparities in Cardiovascular Care<br />
Registration Form (Please Print)<br />
Last Name First Name<br />
Address<br />
City <strong>State</strong> Zip<br />
Email Degree Last 4 Digits <strong>of</strong> SS#<br />
Phone Fax<br />
Hospital Affiliation:<br />
Payment Type<br />
VISA MC CC#: Expiration:<br />
Signature:<br />
SECOND ANNUAL<br />
URBAN CARDIOLOGY<br />
Reducing Disparities in Cardiovascular Care<br />
Saturday, April 14, 2012<br />
7:30 a.m. – 4:00 p.m.<br />
The Westin Book Cadillac Detroit<br />
1114 Washington Boulevard<br />
Detroit, Michigan 48226<br />
Sponsored by<br />
<strong>Wayne</strong> <strong>State</strong> <strong>University</strong> School <strong>of</strong> Medicine<br />
NONPROFIT<br />
US POSTAGE<br />
PAID<br />
DETROIT MI<br />
PERMIT No 3844<br />
<strong>Wayne</strong> <strong>State</strong> <strong>University</strong> School <strong>of</strong> Medicine<br />
<strong>Division</strong> <strong>of</strong> Continuing Medical Education<br />
4201 St. Antoine, UHC 9A<br />
Detroit, Michigan 48201<br />
Check: Please make check<br />
payable to <strong>Wayne</strong> <strong>State</strong><br />
<strong>University</strong> and return with<br />
registration form to:<br />
<strong>Wayne</strong> <strong>State</strong> <strong>University</strong> School <strong>of</strong> Medicine,<br />
<strong>Division</strong> <strong>of</strong> Continuing Medical Education,<br />
4201 St. Antoine, UHC 9A<br />
Detroit, Michigan 48201<br />
or fax to (313) 577-7554<br />
<br />
Special Request:<br />
If you have a disability and require additional<br />
accommodations in order to fully participate in<br />
this activity, please check here and you will be<br />
contacted by the conference manager.<br />
Website: www.med.wayne.edu/cme
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