CVT
Study Group/PHOENIX: Spring 2010
Registration Includes Study Booklet
VHCTAz member: $150
Non-member (includes 1 year optional membership): $186
You MUST
indicate one of the following locations:
____ East Valley Location
____ Phoenix Location
___ I
prefer to waive the 1 year membership for VHCTAz and pay the
non-member registration fee.
|
|
| Name: |
| Hospital: |
| Phone:
Fax: |
| Email: |
| Visa, MC, Discover, AMEX #: |
| Exp. Date:
Amount: |
| V-code: |
| Credit card
billing address zip code: |
| Credit card holder's name: |
|
Signature: |
|
See above for fax number or address. |
CVT
Study Group/TUCSON: Spring 2010
Registration Includes Study Booklet
VHCTAz member: $150
Non-member (includes 1 year optional membership): $186
|
___ I
prefer to waive the 1 year membership for VHCTAz and pay the
non-member registration fee.
|
|
| Name: |
| Hospital: |
| Phone:
Fax: |
| Email: |
| Visa, MC, Discover, AMEX #: |
| Exp. Date:
Amount: |
| V-code: |
| Credit card
billing address zip code: |
| Credit card holder's name: |
|
Signature: |
|
See above for fax number or address. |
Your
Brush with Success: 3/11/10
VHCTAz member: $65
Non-member (includes 1 year optional membership): $101
|
____ Please indicate if a
vegetarian meal is required.
___ I
prefer to waive the 1 year membership for VHCTAz and pay the
non-member registration fee.
|
|
| Name: |
| Hospital: |
| Phone:
Fax: |
| Email: |
| Visa, MC, Discover, AMEX #: |
| Exp. Date:
Amount: |
| V-code: |
| Credit card
billing address zip code: |
| Credit card holder's name: |
|
Signature: |
|
See above for fax number or address. |
Valley
Fever: 3/18/10
VHCTAz member: $65
Non-member (includes 1 year optional membership): $101
|
____ Please indicate if a
vegetarian meal is required.
___ I
prefer to waive the 1 year membership for VHCTAz and pay the
non-member registration fee.
|
|
| Name: |
| Hospital: |
| Phone:
Fax: |
| Email: |
| Visa, MC, Discover, AMEX #: |
| Exp. Date:
Amount: |
| V-code: |
| Credit card
billing address zip code: |
| Credit card holder's name: |
|
Signature: |
|
See above for fax number or address. |