Title:________________________________________________________________________________
Name:_______________________________________________________________________________
Address:_____________________________________________________________________________
City:_________________________________ State:____________________ Zip: __________________
Daytime Phone: __________________________________-____________________________________
E-mail Address:_______________________________________________________________________
Method of payment: ❑ Check/Money order (enclosed) or
❑ Please charge my: ❑ MasterCard ❑ Visa
Enrollment Fees: $ ____________________________________________________________________
(See fee schedule below)
Card No.:_________________________________________Security Code________________________
Signature: ________________________________________Exp. Date:___________________________
Select Conference Location
|
❑ Auckland June 19-20, 2010 ❑ Sydney June 26-27, 2010 ❑ Jamaica August 8-13, 2010 |
Tuition:
Early Registration:
Physicians $895 USD
Registrars and Technologists $445 USD
Auckland Only: Physicians $695 USD; Techs $295 USD
Registrars...FREE 12 seats have been reserved for Registrars in Auckland for 3rd, 4th and final year registrars.
These free registration seats are through Dr Neal Steward and not through the web site.
"The Early Bird Tuition has been extended up to the meeting!" Register on-line at
www.mskmr.com or Mail
completed form and payment to: DW Renner • 3517
Brookwood Meadow• Cincinnati, Ohio 45208 Make checks payable to . DW Renner FAX CREDIT CARD REGISTRATIONS to (513) 898-5355 ph: (513) 235-5215 • fax: (513) 898-5355