Symposium Registration

"YES, WE CAN ... THINK OUTSIDE THE BOX"
A Conference on Science-Based Medicine
February 19 –20, 2011

Name (as it should appear on certificate)
 
Degree:
         
Institution Affiliation:
Mailing Address:  
City:    State:    Zip:
Telephone:      Fax:
E-mail Address:    
* License Number:
(M.D. not required)
How did you hear about this symposium?
                
Please let us know if you have a Promo Code:
Symposium Fees:  


Method of Payment:  
     
Cardholder Name
Card Number    Expiration Date:

*Note: to register for CMEs, please mail letter from the Fellowship/Residency Director to:

The Robert Fishman Institute for Training & Research
4401 Sheridan Street
Hollywood, Florida 33021

If you must cancel for any reason, notify us via fax at 1-800-528-8984 or e-mail at admin@therobertfishmaninstitute.com, 30 days prior to the conference. Your registration will be refunded to you less a $250 processing/handling fee for medical professionals and $100 for non-medical professionals. Cancellations within 30 days of the conference are non-refundable. However, you may transfer your registration to another person via fax or e-mail notification up to 24 hours prior to the conference.