Comprehensive Practical Laser and Light Source Training |
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Program Schedule: Day 1
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Program Schedule: Day 2
(*) = (Devices available depend on sponsor) |
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A course booklet containing all presentation material will be provided to each attendee for future reference. All two day courses qualify for 12 hours of Category I Continuing Educational Credits. Courses are limited to 20 attendees. |
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| 1. REGISTRANT INFORMATION |
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Name:__________________________________ Address:________________________________ City:___________________________________ State:_____________________ Zip:_________ Phone:_____________________________ |
Billing Address (if different) Address:________________________________ City:___________________________________ State:______________________ Zip:________ Phone:______________________________ |
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| COURSE LOCATION: _____________________________________ DATE:__________________ |
| 2. TUITION | |||||
$1,695 per Physician / Nurse, Tech. ................................. $______________ $200 for 12 Hours of Category I CME's.............................. $______________ TOTAL .......................................................................... $______________ |
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Please bill my credit card:
Visa
Discover
American Express
Mastercard |
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| CC# |_____|_____|_____|_____|_____|_____|_____|_____|_____|_____|_____|_____|_____|_____|_____|_____| | |||||
| Customer Signature _____________________________________________ CC Exp:_______________ | |||||
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Medical Laser Dynamics, Inc. Course Fax Form
1301 W Justin Road, Suite 201-479, Lewisville, TX 75077, Office: (888)363-7930, Fax: (972)317-8478 |
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