Regional Conference Registration Form

Conference Selection

Healthcare Allocation -- Slicing the Pie: Who Decides?
Madison, WI

Personal Information

^*Name: -- Dr. Rev. Fr. Mr. Mrs. Ms.                                     

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^*Home Phone:  Work Phone:

Fax: ^*Email:                                    

^*Occupation:  -- Pharmacist Physician Nurse Clergy Religious Denominational Leader Attorney Medical School Faculty Educator (Non-medical) Physician Assistant Scientist Student Other
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^*How did you hear about this conference?  -- Brochure E-mail announcement CBHD website Other

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Conference Options and Fees

$113 Conference Registration with 7.5 hrs. of CME credit for Physicians

$75 Conference Only (no CME credit)

$30 Student

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Method of Payment

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