Online METS Conference Registration Form


Please Note - Conference registration is from 5-7pm on the first day.  The first teaching session begins at 7pm and the conference will conclude by noon on the 3rd day.


Payson, AZ (October 1-3, 2010)

Name
 (For name tag)
Sex
Male      Female
Degree
Specialty
First Name
Last Name
Spouse Name
 (If Attending)
Spouse Specialty
 (If Medical)
Address
Home      Office
Street Address
Address Line 2
City
State
Zip Code
Country
E-mail
 (For confirmation email)
Home Phone
Work Phone
Comments

Please Select Category. For couples at different levels, the higher rate will apply.

Category
For couples at different levels, the higher rate will apply.

Single

Couples
Professionals (Physicians, NP, PA, Pharmacists)

$100*

$200*
All Others

$50*

$100*

Residents & Students:
      Free housing in host homes (limited availability)
      Hotel (Make own arrangements-see below)

$50

$100

*Price includes Conference and meals.

Hotel Information:

Best Western Payson Inn
$119-deluxe rooms no-smoking 2 queens
King and Queen size beds available
Phone number 1-800-247-9477 for reservations
Breakfast included
Reservation deadline September, 12, 2008
www.bestwesternpaysoninn.com

Additional Required Information - Please select all that apply

METS Alumnus
Prefer Vegetarian Meals
CME $150 additional
Provided by Loma Linda University Medical Center
CEU $46 additional
Provided by Hospital Christian Fellowship

Payment

You may pay for your conference with a credit card online (through PayPal) or by mailing your payment by personal check. Please choose your prefered method of payment from the two choices below.

Online Credit Card Payment     Mail A Check

               




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