AO ASIF Principles of Fracture Management/Advanced Controversies in Fracture Care Registration Form

March 25 - 30, 2000
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: Colorado Springs Principles of Fracture Management/Advanced Controversies in Fracture Care
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):


Social Security Number:

Guest's Name (if any):

Mailing address:

Home Phone:

Work Phone:

E-mail address:

Fax Number:

Hospital Affiliation:

City:

Please indicate - will you attend the Course dinner?:
Yes
No
Guest ticket: $40.00 each (payable with tuition)
APPLICATIONS WILL NOT BE ACCEPTED UNLESS TUITION FEES AND A COMPLETED PRE-COURSE QUESTIONNAIRE 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
I
II
III
IV
V
2. Private Practice?:
Yes
No
3. Are you considering trauma as a career choice in orthopaedics:
Yes
No
4. What are your expectations for the upcoming AO Course? Please explain in as much detail as possible:

Please press this button
to submit your registration form:

Thank you.