Course Registration

* Registration Not Confirmed until Payment is Received.
Please use the form below to register online

Name
Address
City
State
Zip
Phone
Cell Phone  
Fax
Medical License#
Medical Specialty
Email Address
Accompanying Staff  
  *Fees may apply and space is limited
Course Name  
Course Date  
Supplemental Training       
  *Preceptors may offer additional training (additional fees required & space is limited)
Comments
  Cancellation Policy: Registration is 90% refundable only if a written cancellation is received 2 weeks prior to the scheduled workshop.
Course dates & times subject to change.
 

Click here to download the registration form in PDF format and
fax it to 520.545.1254
If paying by check, send completed form & check to:
FAME (Foundation for the Advancement of Medical Education)
8000 S Kolb Rd, Ste 102
Tucson, AZ 85756