GENERAL INFORMATION AND REGISTRATION
HOT SPOTS HAWAII - 2012
AUGUST 17 - 19, 2012
Physicians: $300
After June 1, $350
On-Site Registration:To Be Decided
Nurses and Residents: $100.
After June 1, $200
Students: Free
Cancellation Policy: A $50 non-refundable fee is charged for cancellations before July 1. Thereafter one half of the fee will be returned for cancellations received before July 30. No refunds can be accepted after that date. All cancellations must be in writing.
Please email us for a Printable Registration Form at HS Form or scroll down for a form you can cut and paste:
To contact us:
Dave Elpern
Phone: 413-458-2800
Email: djelpern@gmail.com
Copy, Paste, Fill in and fax or mail the following form to us with registration check. You can also email us for this Registration Form at DJE.
GENERAL INFORMATION AND REGISTRATION FORM
HOT SPOTS HAWAII -- AUGUST 17 - 19, 2012
Physicians: $300 After June 1, $350
Nurses and Residents: $150. After May 1, $200
Students: Free
Cancellation Policy: A $50 non-refundable fee is charged for cancellations before July 1. Thereafter one half of the fee will be returned for cancellations received before July 30. No refunds can be accepted after that date. All cancellations must be in writing.
Please copy, fill out form and make check payable to:
"Kauai Foundation - Hot Spots Hawaii"
c/o The Skin Clinic
12 Meadow Street
Williamstown, MA 01267
Date:____________________________
Tuition fee enclosed: $_________
Total: $_________
Full Name: Last________________ First____________ Middle Initial____
Title__________________________Affiliation____________________________
Daytime Phone ( )______________Fax Number ( )________________
Email Address _______________________________
Street Address_______________________________________________
City_________________________ State__________ Zip Code_________
Specialty ______________________________________
Specialty (if non-MD)_____________________________________
Degree__________________
