Print Out Order Form: Chicago Seminar on Medical Errors - 2004
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| Health-care Institution | |
| Street Address
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Zipcode
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| Telephone
Fax
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| Attendee's E-mail
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| Department
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| Title of Attendee
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| Payment | $199: Early bird (Still Good Till May 17, 2004 - Deadline) |
| $375: Two from the same institution (Still Good Till May 17, 2004 - Deadline) |
| $499: Three from the same institution(Still Good Till May 17, 2004 - Deadline) | |
| $299: One person After May 17, 2004. $399 at the door |
Please fax information to Lara Publications at 314-653-6543 and Send by mail with check to Lara Publication, Medical Error Seminar, 12382 Trail Forest lane, Florissant, MO 63033
Any questions call 800-599-7313