Registration Form
The 35th Annual Review and Recent Practical Advances in Pathology
The Alexander All-Suites Oceanfront Resort, Miami Beach, Florida
January 25 - 29, 2010
Last Name:
First Name: Middle Initial:
Specialty: Degree:
Social Security # (last 4 digits only) for CME Purposes:
If you are a foreign participant and do not have a Social Security #, please enter 1111.
Type of Practice:
Preferred Mailing Address:

If using institutional address, please include department (if applicable) and institutional name
Department:
Institution:
Street:
City: State: Zip Code:
Country:
Phone: Fax:
Email:
Registration Fees

Registration fees include admission to the scientific sessions, conference materials, a daily continental breakfast and refreshment breaks. Attendees may choose to have the handouts in CD-ROM or a hard copy. If you choose to receive BOTH - CD-ROM and a hard copy - please add $50 to registration fee below.
Postmarked by Dec 01, 2009
Postmarked After Dec 01, 2009
On-Site
1. Physicians In Practice
2. Physicians In Training*, Active Duty Armed Forces*, UM/JMH Alumni and Retired Physicians
3. Medical Students, PAs, Technologists
4. Current UM Medical Students, Department of Pathology Volunteers and Observers









Please select one (1):




CANCELLATION POLICY: Refunds (less $70 cancellation fee) will be made ONLY if cancellation notice is received postmarked by December 14, 2009. No refunds will be issued after that date. Refund will be processed after the conference.

For questions please feel free to contact Ms. Alicia Cabrera, Program Coordinator at:

University of Miami Miller School of Medicine
Department of Pathology
1611 NW 12th Avenue
JMH/Holtz Bldg., Room 2147
Miami, Florida 33136
Phone: (305) 585-6194
Fax: (305) 585-2598