Symposium Reservation Form

* Name (Last, First, MI):

* Company Name:

* Office Phone:

Fax:

* Email Address:

* Confirm Email Address:

* Mailing Address:

* City:

* State/Province:

* Zip Code:

* Country:

Accompany Person(s) Name(s):
(include age if child)

 Age
Age

RWCS Conference
Includes all breakfasts, social functions, coffee breaks

Early Bird
(up to Oct 15)

Regular
(after to Oct 15)

Late Registration
(after to Jan 1)

Total Fees
Physician

$495

$550

$600

Physician Rheumatology Fellow *

$200

$250

$300

RN NP PA Office Personnel

$300

$350

$400

Spouses and Guests

$145

Registration for Spouses and Children include all breakfast and dinner events.

Children (over the age of 10)

$95  

Children (under the age of 10)

Complimentary

Afternoon Workshops
(1:30 - 3:00 PM)

Will Attend
  
Musculoskeletal Ultrasound (Wed)

Yes

Due to industry support, the workshop fee has been waived.
Advance Registration Required.
In-Office Extremity MRI (Thu)

Yes
Electronic Medical Record (Fri)

Yes
Office Based Procedures (Sat)

Yes

Register Early: Workshop space is limited based on first-come, first served basis. On-site subject to availability.

NOTE: RWCS reserves the right to cancel any workshop for lack of attendence.

Exhibitor

Early Bird
(up to Oct 15)

Regular
(after to Oct 15)

Late Registration
(after to Jan 1)

Total Fees
Additional second or third person (each)

$300

$300

$350

Grand Total Fees

Payment Information:

Cardholder Name:

Payment Type:

Card Number:

Card Expiration Date:

CID:

Payment Amount:

 $

Make Checks Payable To:

 ACMD / Hawaii

Send To:

 HTC INTL
333 N. Michigan Ave.
Chicago, IL 60601

Administrative Office:
Rheumatology Winter Clinical Symposium 2008
41 East Lipoa Street, Suite 21 Kihei, HI 96753

Contact:
Phone 858-385-0785 Fax 858-683-2027
Email information.services@r-w-c-s.com

2007 © • Rheumatology Winter Clinical Symposium • All Rights Reserved