SFIMMS Registration


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Please complete and print this form and return to:

San Francisco International Manual Medicine Society
4104 24th Street, Suite 504, San Francisco, CA 94114

You can also contact us through email or click here to register online.

Participant

Name Title
Organization
Address
City State Zip
Phone Fax Email

MD/DO PT Resident

Courses

Course Fees Only (does not include lodging)
May 16-18, 2008 — $675 ($625 before Dec 15, 2007)
Core Clinic, San Jose, CA (click here for more info)
Local accomodations can be made at Oakwood - San Jose
Fri 1:30 – 5:30 pm, Sat 8:30 – 5:30 & Sun 8:30 – 4:00
Payment

My check of $ made out to SFIMMS will arrive in 15 days or I forfeit my standing (payment enclosed—for those mailing in the form).
Please charge $ to my credit card: Visa MasterCard
Credit Card Number:
Expiration month/year:
Cardholder's name
A purchase order for the full amount is enclosed
I accept the charges chosen above
Signature


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