Link to printable version of the Registration Form:  Registration form 9-5-07.doc

 

 

OREGON BONES FALL CONFERENCE

November 8-9, 2007

 

REGISTRATION FORM

 

Name____________________________________________________

 

Clinic ___________________________________________________

 

Title_____________________________________________________

 

Address__________________________________________________

 

City/State/Zip_____________________________________________

 

Phone Number____________________________________________

 

E-Mail__________________________________________________

 

2007 Oregon 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)

 

$150.00  Oregon Bones Member (paid), Manager (named above)

 

$  75.00  Oregon Bones Member (paid), each additional Manager

 

 (2)_______________­­_____________________ (3)_____________________________________

 

$100.00  Oregon Bones Member, (paid), each Non-Manager Staff person

 

(1)_____________________________________(2)_______________________________________

 

$200.00   Non-Oregon 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

Salishan Spa & Golf Resort

7760 Highway 101 North

Gleneden Beach, OR 97388

Reservations: 1-800-452-2300

 

**  Oregon BONES Conference Attendee Group Rate is $130 **

 

REGISTRATION MUST BE RECEIVED BY October 31, 2007

 

Do you plan on attending Thursday night Social Event?  YES  NO   Guest?  YES  NO__

 

 

 
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