OREGON BONES SPRING CONFERENCE

All Staff Event

April 19, 20 2007


REGISTRATION FORM

Name_______________________________________________________________

Clinic _______________________________________________________________

Title_________________________________________________________________

Address______________________________________________________________

City/State/Zip__________________________________________________________

Phone Number_________________________________________________________

E-Mail________________________________________________________________
2007 Bones Membership ( per calendar year - $100 per Admin/Manager; $50 per Ancillary staff person)
You may include appropriate “membership fee” with conference registration if not previously sent.

Registration Fees: (circle appropriate fee for each attendee)

$200.00 Bones Member, 1st registration (named above)

$150.00 Bones Member, 2nd & 3rd registration (each)

(2)______________________________________ (3)_________________________________________

$100.00 Bones Member, 4th, 5th or more registration (each)

(4)______________________________________ (5)_________________________________________

$300.00 Non-Bones Member


Please submit this registration form & fee to :  
      Tona Springer – Secretary-Treasurer
      C/o Cascade Orthopedics & Sports Medicine Center, PC
      1715 E. 12th Street
      The Dalles, OR 97058
Questions: Please call 541-296-2294 or E-Mail tonas@cosmc.com

MEETING LOCATION

Hotel deLuxe
729 SW 15th Ave. Portland OR
Reservations: 503-219-2094
** Mention that you are a BONES Conference Attendee for the $129 room rate**

REGISTRATION MUST BE RECEIVED BY April 1, 2007

Do you plan on attending Thursday night Board Meeting? YES NO

 

 
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