SEAK,
Inc. Cape Cod, August
2006 REGISTRATION FORM
To register, call SEAK,
Inc. at 508-457-1111, or Print this form and complete the requested information
(neatly, please),
and FAX to SEAK, Inc. at 508-540-8304, with
credit card information. Or mail with credit card information or check to: SEAK, Inc. P.O. Box
729, Falmouth, MA 02541
priority code: web
Please register me for:
___How to Start and Build a
Successful Expert Witness Practice
($495)
Cape Cod August 16, 2006
___Medical Malpractice Survival Training
($495) Cape Cod August 16, 2006
___How to Be an Effective Medical Witness
($995) Cape Cod August 17-18, 2006
___Legal Liability Prevention for Physicians: 2006
($1,195)
Cape Cod August 17-18, 2006
___Non-Clinical Careers for Physicians
($1,195) Cape Cod August 19-20, 2006
___2006 IME Summit
($1,195) Cape Cod August 19-20, 2006
$_______ Amount
Enclosed
Payment Info
Please print or
type all information. Use abbreviations as necessary.
|
□
I'm paying by credit card
or
Check Enclosed (made out to
SEAK, Inc.)
□ |
| Type of card: ___Visa
___MC ___AmEx |
Exp. Date: |
Credit Card #:
|
| Name |
| Name of Organization |
| Address
|
| City
State
Zip |
| Phone Fax |
| E-Mail |
| Specialty |
SEAK, Inc. FAX
(508) 540-8304