The 25th Annual Children's National Medical Center Symposium ECMO & Advanced Therapies for Respiratory Failure
Keystone, Colorado, USA       February 22 – 26, 2009

Fax Registration: Please note that the correct fax number for registration is (202) 476-3459

Registration Form
All fields marked with an * below are required.

Name:
Last Name *First Name *M.I.MD, RN, etc.
Title:
Hospital:
Department:
 
Mailing Address:

Line 1: *

Line 2:

City *State *Country *Postal Code *
 
E-Mail Address: *
Telephone:
Country
Code *		City Code *Number *
Fax:
Country
Code		City CodeNumber
For the United States the country code is 1. The city code is also known as the Area Code.
 
Will you attend the banquet?   yes  no
If yes, how many guest tickets do you require ($50 per)?    0  1  2  3
 
Registration Fees:  *(Must Select One Below)
 Physician: $640
  Physician with CME: $680
 Non-Physician: $550
  Non-Physician with CME: $590
  Exhibitor: $3000 - Company Name:
 
Total Cost:
 



Note: If you encounter errors or have difficulty in registering on this page, please contact the WebMaster directly, and detail your problem.

Cancellation Policy: Refunds will be made only for written cancellations received prior to February 1st, 2008 . A $50.00 administrative fee is charged on all refunds.

If you prefer to pay by check, please make your check payable to:

CNMC ECMO Symposium

and mail it to:

BIllie Lou Short, MD
Department of Neonatology
Children's National Medical Center
111 Michigan Ave., NW
Washington, DC USA 20010

Other questions? Contact Us:

Department of Neonatology
Children's National Medical Center
111 Michigan Ave. N.W.
Washington, DC, USA 20010

Questions? Drop us an e-mail to: Information


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