2010 Registration

  CONTACT INFORMATION
* Required
*First Name: *Last Name: *Degree:
*Address:
*City:
*State:
*Zip code:
*Country:
*Phone: Fax:
*E-mail:

Please select your primary practice operation:
Private practice  
Hospital-based  		  

Special Dietary Request:
(please select one)


Kosher   Vegetarian   No preference

 
*How did you hear about the meeting?
 Multiple selections allowed
Print Advertisement
Brochure
Postcard
Letter
IDC NY e-Newsletter E-mail		 PediatricSuperSite.com and/or News Wire
Internet search
Word of Mouth
Phone
Exhibit Booth Flyer
Priority Code
Please enter the priority code found on the lower right-hand corner
of your brochure registration form or other marketing materials.
CME Activity Request
Yes, I would like the opportunity to earn CME credits through future activities jointly sponsored by Infectious Diseases in Children and Vindico Medical Education.

  *REGISTRATION TYPE
 

Early-bird Registration
  A. Physicians............................................................US$ 445
  B. Nurses/Allied Health Professionals .....................US$ 325
  C. Residents*............................................................US$ 325
        *Residents/students must submit a letter of verification at time of registration.
 

Preregistration
  D. Physicians ...........................................................US$ 545
  E. Nurses/Allied Health Professionals.......................US$ 395
  F. Residents*.............................................................US$ 395
        *Residents/students must submit a letter of verification at time of registration.
 

Onsite Registration
  G. Physicians ...........................................................US$ 645
  H. Nurses/Allied Health Professionals.......................US$ 495
  I. Residents*..............................................................US$ 495
        *Residents/students must submit a letter of verification at time of registration.

   *BILLING INFORMATION
   (check if the same as Contact Information at top of page)
*Accountholder's Name:
*Statement Mailing Address:
*City:
*State/Province:
*Country:
*Postal Code:



Contact Information
You can register online using the REGISTER button above, or print the form and ...
FAX THE FORM: 856-251-0278
MAIL THE FORM: Registration Department
6900 Grove Road, Building 100
Thorofare, NJ 08086-9447
REGISTER VIA TELEPHONE: 877-307-5225, ext. 219 or 476 or
+(1) 856-994-9400 (Outside the U.S.)
OFFICE HOURS:

Monday - Friday, 9:00 AM - 5:00, EST

For more information, contact Vindico Medical Education by e-mail: meetingregistration@VindicoMedEd.com

Requests for refunds must be submitted in writing by November 12, 2010. There will be a $200 service charge for all refund requests.