Event Registration - Step 1

Event:Central States Occupational and Environmental Medicine Association
Occupational Medicine: Where Medicine Meets the Workplace
88th Annual Spring Seminar
Dates:March 15-17, 2012
Location:Hilton Lisle/Naperville Hotel in Lisle, IL

* Name:
Degree:
* Nickname for Badge:
Business Name:
Address:
City:
State:
Zip:
* Phone:
Fax:
* Email:
 I do NOT wish to have my e-mail address published in the attendance list.
Check here if you are an:  ACOEM Member  ACOEM Fellow  ACOEM Master 

* Select at least one event option
Register me for the one-day seminar on March 15, 2012 for $175  
I wish to purchase a printed syllabus book for $25 (USB of one-day handouts provided free)  
Register me for the spring seminar on March 16 & 17, 2012 for $250  
I wish to purchase a printed syllabus book for $25 (USB of two-day handouts provided free)  
 
 Foundation donation from credit card: $


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