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Registration: Obstetrical Malpractice: A Survival Guide

Registration includes attendance at all lectures, syllabus, CME credits, continental breakfast, lunch and coffee breaks.

Cancellations: Refunds will not be issued for cancellations received after December 16, 2015. A processing fee of $40.00 will be retained on all cancellations.

Contact Information

Title

First Name

Last Name

Facility or Organization Name

Mailing Address

Unit, Suite, or Apartment

City

Province / State

Country

Postal / Zip Code

Business Phone

Fax

Your E-Mail Address

Please indicate your profession:

Profession Please select one

Obstetrician
Family Physician
Nurse
Nurse Practitioner
Midwife
Lawyer
Law Clerk
Risk Management
Resident/Fellow/Student

Payment Amount

Fee Group	Early Fees (on or before December 16, 2015)	Late Fees (after December 16, 2015)
Residents/Fellows	$100	$125
Nurses & Midwives	$150	$175
Family Physicians	$200	$225
Obstetricians/Lawyers/Insurance Professionals	$250	$300

I will be submitting the following fee:

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