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Registration

Pediatric Emergency Physician Conference
October 30-31, 2008


If you have already registered, do not use this form to modify your information. Please email us to make name and address changes.

Contact Information

Mr / Miss / Ms / Dr:
*First Name:
*Last Name:
Title:

Organization

Employer:
*Address:
Address (2):
*City:
*State:
*Zip Code:
Check if work address:
Business Phone:
Home Phone:
Cell Phone:
*E-mail:

Registration Type


Other Considerations

Special Diet? :
Special Needs? :

Breakout Sessions

Please select your first and second choice for each of the breakout sessions:


Thursday 1:30 am - Sessions

Thursday 2:30 pm - Concurrent Sessions repeated

Friday 2:00 pm - Sessions

Friday 3:00 pm - Concurrent Sessions repeated

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