AO ASIF Nursing Continuing Education Presents:
Orthopaedic Trauma:
Team Approach to Fracture Management
Basic Course for Operating Room Personnel
Course Registration Form

Please do not consider yourself registered in this Course until written confirmation is received.

Course Name:

Enclosed is my check payable to:
AO ASIF CONTINUING EDUCATION

Please charge my credit card:

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


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:


AO ASIF Consultant:

• Registration is required in advance and is not accepted unless accompanied by appropriate fees. Phone-in registrations cannot be accepted.
• Registration deadline: August 8, 2003. Refunds will be issued if written cancellation is received by this date.