AO ASIF Nursing Continuing Education Presents:
Team Approach to Fracture Managment
Basic and IM Nailing/External Fixation Courses for Operating Room Personnel
Course Registration Form

April 25 - 26, 2003
Hyatt Regency Newport
Newport, Rhode Island

Course Name:

Indicate which course you wish to attend:

Basic Course (April 25-26, 2003)

IM Nailing/External Fixation Course (April 25-26, 2003)

Attendance may not be split between courses. IM Nailing/External Fixation Course attendees must have completed a previous Basic Course.

Basic Course Attended:
Date: Location:

Enclosed is my check payable to:
AO ASIF CONTINUING EDUCATION

Please charge my credit card:

Exp. Date: Card Number (required):
Signature (Signature of card holder required, if faxing or mailing form):


Complete all information as you wish it to appear on certificate (type or print clearly)

Name (as it should appear on your certificate):


Credentials (i.e., RN, CST, etc.):


Social Security No. (for identification purposes only):


Home address:


City:
State:
Zip:

Home Phone:
Office Phone:
Office Fax:

Name and City of Hospital:


Sales Consulant's Name:

Wheelchair Acessible Do you have any special needs:

If you are registering and paying by check, please print and mail this registration form with payment to:

AO ASIF Nursing Continuing Education
RE: Newport, Rhode Island ORP Course

1301 Goshen Parkway
West Chester, PA 19380
Tel (800) 535-2369 (press 6)
Fax (610) 719-6532

Please do not consider yourself registered for this course until written confirmation is received.

Please press this button to submit your
registration form online using your credit card:

Thank you.

Course Information