AO ASIF Nursing Continuing Education Presents:
Team Approach to Fracture Managment
Basic and IM Nailing/External Fixation Courses for Operating Room Personnel
Course Registration Form

Course Name:

Indicate which course you wish to attend:

Basic Course (September 19-20, 2003)

IM Nailing/External Fixation Course (September 19-20, 2003)

Attendance may not be split between courses. IM Nailing/External Fixation Course attendees must have completed a previous Basic Course.

Basic Course Attended:
Date: Location:

Enclosed is my check payable to:
AO ASIF CONTINUING EDUCATION

Please charge my credit card:

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


Complete all information as you wish it to appear on certificate (type or print clearly)

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:


Sales Consulant's Name:

• Registration is required in advance and is not accepted unless accompanied by appropriate fees. Phone-in registrations not accepted.
• Please do not consider yourself registered for this course until written confirmation is received.
• Registration deadline: September 12, 2003. Refunds will be issued if written cancellation is received by this date.

AO ASIF Nursing Continuing Education
RE: Scottsdale ORP Course
1301 Goshen Parkway
West Chester, PA 19380
Tel (800) 535-2369 (press 5)
Fax (610) 719-6532

Please do not consider yourself registered for this course until written confirmation is received.

Please press this button to submit your
registration form online using your credit card:

Thank you.