PND / NIH Medical Symposium on
Pediatric Neurotransmitter Diseases
May 18th - 19th, 2002 Bethesda, Maryland
Symposium Registration Form
After filling
in the information below, print this completed form and mail it, with
the registration fee,
to the PND Association address located at the
bottom of this page.
Registration Fee:
Payable
to PND Association in US Currency.
Registration
includes symposium, continental
breakfast, coffee break and lunch.
The NIH/FAES has approved this symposium for 10.5 CME category 1 credits.
$195.00
No Fee - If
you are a NIH employee or affiliate there is no fee.
Please provide NIH contact information below.
Personal Information
Salutation: Please
Check One
Dr.
Prof.
Mr.
Mrs.
Ms.
First
Name:
Last
Name:
Degree:
Affiliation:
Title:
Name: (to
appear on your
conference badge)
Address:
Address:
City:
State:
Postal
Code:
Country:
Business
Telephone:
Fax:
Email:
Require assistance:
The NIH/FAES is accredited by the
Accreditation Council for Continuing Medical Education to sponsor
continuing medical education for physicians.
The NIH/FAES designates this
educational activity for a maximum of 10.5 hours in category 1 credit
towards the AMA Physician's Recognition Award. Each physician
should claim only those hours of credit actually spent in the
educational activity.
If you require additional information or assistance
in competing this form, please contact us at
(516) 937-0049 (phone and
fax) or PND@PNDASSOC.ORG
After filling in the registration form, print the
completed form and mail it, with the
registration fee of $195 payable in US
currency to the PND Association at:
The
PND Association
Attn: Medical Symposium Registration
6 Nathan Drive
Plainview, NY 11803