THE 32nd ANNUAL
CARROLL P. HUNGATE POSTGRADUATE SEMINAR
ON OCCUPATIONAL AND ENVIRONMENTAL HEALTH
FEBRUARY 26-27, 2010
Doubletree Hotel, Overland Park, Kansas Please complete and print the following form and return to us by mail or fax.
[ download the PDF Brochure ]
Name: Degree: Specialty: Address: City: State: Zip: Office Telephone: Fax: E-Mail:
How did you hear about this meeting?:
Registration Fee (Select one which applies): Select one CPCOEM Mem. Physician Entire Program $195 GPCOEM Mem. Physician - Fri only $140 GPCOEM Member Physician Sat Only $130 Non-member Physician Entire Program $215 Non-member Physician Fri Only $160 Non-member Physician Sat only $145 Nurse Members, GKC Chap, AAOHN Entire Prg $160 Nurse Memb., GKC Chap, AAOHN Fri only $120 Nurse Memb., GKC Chap, AAOHN Sat Only $110 Non-member Nurse Entire Program $170 Non-member Nurse Fri only $130 Non-member Nurse Sat only $120 Other Professionals Entire Program $195 Other Professionals Fri only $140 Other Porfessionals Sat only $130
Check enclosed (make check payable to: GPCOEM)
Please return completed form by mail to: Great Plains College of Occupational and Environmental Medicine (GPCOEM) 9225 Ward Parkway, Ste. 114 Kansas City, Missouri 64114 Fax (816) 523-3393
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