AO ASIF Hand and Wrist Course Registration Form

March 25 - 27, 2000
The Broadmoor
Colorado Springs, Colorado

Please complete this form in it's entirety to register.

You have the option to print this form, complete and return to:

AO ASIF Continuing Education
Re: Hand and Wrist Course
Colorado Springs, Colorado Course
P.O. Box 1766
Paoli, PA 19301-0800
Tel: (800) 769-1391/Fax: (610) 251-5039

or you can complete this form and submit online using a credit card:

Course Name:


Name:


Degree(s):


PGY:

Social Security Number:

Guest's Name (if any):

Mailing address:
Home Phone:

Work Phone:

E-mail address:

Residency Program:

Have you ever attended an AO ASIF Course:
Yes
No
If so, when and where:

Do you have any special needs?:

APPLICATIONS WILL NOT BE ACCEPTED UNLESS TUITION FEES ARE INCLUDED WITH THE REGISTRATION FORM.
Please make checks payable to:
"AO ASIF CONTINUING EDUCATION"
If you need further assistance, please email delonel@aona.com

Payment method:

Exp. Date: Card Number:
Signature (if mailing or faxing form):
Do you have any special needs:

PRE-COURSE QUESTIONNAIRE-MUST BE COMPLETED FOR REGISTRATION FORMS TO BE PROCESSED


1. Years in Practice or PGY:

2. Do you have a Private Practice?:
Yes
No

3. Are you considering Hand/Wrist Surgical Specialty as a career choice?

4. Percentage of practice dedicated to hand and wrist trauma surgery?

5. What do you expect to learn from the upcoming AO Course? Please explain in as much detail as possible.

Please press this button
to submit your registration form:

Thank you.