SEAK, Inc. Hyannis July 2005
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. PO Box 729, Falmouth, MA 02541

priority code: web
 

Please register me for:
___25th Anniversary Workers’ Compensation and Occupational Medicine Seminar ($795:July 19-21, 2005)

___Return to Work Programs: The Next Generation ($295:July 18, 2005)
___ADA, FMLA, and Workers' Compensation:  In Depth ($295:July 18, 2005)
___Workers' Compensation Legal Issues and Defense Strategies ($295:July 18, 2005)
___Diagnosing and Treating Chronic Pain:  The Multidisciplinary Approach ($295:July 18, 2005)
___Back to the Future: Case Management With a Fresh Look ($295:July 18, 2005)
___Testifying Skills Workshop ($295:July 18, 2005)
___Employment Law: Risk Management In the Workplace ($295:July 18, 2005)
___Injured and Aging Workers: Maximizing the Fit Between Worker and Work ($295:July 18, 2005)

I would like to apply for the following credits (Please check as many as are applicable):

__Attorney      __Case Manager        __Disability Specialist            __MD/DO
         __ Occupational Health Nurse             __ Rehabilitation Counselor            __Nurses

  Check Enclosed (made out to SEAK, Inc.)
  Credit Card Billing Type of card: ___Visa ___MC ___AE
Card No.

Exp.Date:
Signature

Please print or type all information. Use abbreviations as necessary.

Name                                                                                                                                                              Title
Name of Organization
Address
City                                                                           State                        Zip
Phone (Area Code/Number)                                             Fax
E-Mail
Specialty

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SEAK, Inc. FAX  (508) 540-8304