Registration Form

A Global Assembly
April 20-22, 2001

 

Name

SS# (used for CME/CEU processing)

Degree Specialty

Institution

Address City/State/Zip

Phone /Fax/Email

 

Fees: Please choose appropriate fee

  Before March 23 After March 23
Physicians, PA's $150 $190
Nurses, PTs, others $95 $125
Students $28 $35
Conference/no credits $90 $105
*One day Only
*indicate day of attendance 		$35 $40

 

Please indicate type of CEU requested:

CME Social Work Nursing General

Send payment (made payable to The Center of Conferences) to:

The Center for Conferences and Institutes
The University of Iowa
100 Oakdale Hall, W310
Iowa City, IA 52242-5000
Phone: (319) 335-4141 FAX: (319) 335-4039
For phone registration, call 1-800-551-9029