CME Medical Conference Registration

Please fill out the form below and fax to 989-631-2090 or mail to: The National Procedures Inst., P.O. Box 1486, Midland, MI 48641-1486

Register me for the CME medical conferences indicated:
(* indicates a required entry)

Conference Date*

Conference Title*

Conference Fee*

 

Name *
First                                           Last

Title *

Specialty  *

Position  *

Institution

Billing Information:

Street Address*

City*

State*        Zip Code*      Country*  
        

Shipping Information:

Street Address

City

State        Zip Code      Country 
        

Phone Number*

Fax Number *

E-mail Address*


May we contact you at this address regarding new courses/products/updates?
YesNo

How did you hear about us?

** If you are taking any NPI CME medical conference in Las Vegas, Chicago, Boston, or Denver please add $100 surcharge (per person, not per course).
Please review our policies.

Course Fee*

Surcharge**

Less Discount*

Total Due*
                  

Check our Discounts page to see if you are eligble.
 

Charge My Credit Card *

Card Number*  

Expiration Date*     

Enter any other comments you may have