Cardiorespiratory Diagnostics
2009 Seminar Registration Form
| Date:
October 12-14, 2009 |
Tuition:
$690.00 |
Please print this form.
Print to ensure correct spelling on your certificate of course
completion.
Name:_______________________________________________________
Credentials:_________________AARC Member
#:____________________
Title:________________________________________________________
Facility: _____________________________________________________
Address:_____________________________________________________
City/State/Zip:_________________________________________________
Phone:________________________Fax:___________________________
Email:_______________________________________________________
Payment may be made by check, money order,
Visa or MasterCard.
( ) My check
for $_______ made payable to Medical Graphics Corporation, is enclosed.
( ) Please
charge _____ registration(s) to my credit card for a total of $_______
( ) MasterCard
( ) Visa
| Card No.:___________________________________
Expiration date: _______ |
| CVV number from the back of
the card: _________ Today's date: __________ |
| Print Cardholder Name:______________________________________ |
| Cardholder Signature: _______________________________________ |
| Billing Address: ____________________________________________ |
| City/State/Zip: _____________________________________________ |
Note: Topics, faculty, presentation
times, and schedule are subject to change.
Please return this registration form with
your tuition payment to:
Medical Graphics Corporation
Educational Programs
350 Oak Grove Parkway
St. Paul, MN 55127-8599 |
Contact:
Courtney Gaul
Email: seminar@medgraphics.com
Tel: (800) 950-5597
Fax: (651) 379-8244 |
|