Continuing Medical Education - Genesys Health System | Grand Blanc, MI

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Congdon Lecture Series - Enrollment Form

Genesys Home > Education > Physician Education > Congdon Lecture Series

Please select the month(s) that you would like to enroll in the

Congdon Lecture Series:

January
February
March
April
May
June
July
August
September
October
November

2012 Congdon Agenda
January 11, 2012 - Pediatric
February 8, 2012 - Cardiology
March 14, 2012 - Addiction Medicine
April 11, 2012 - Ethics & Palliative Care
May 9, 2012 - Obesity
June 13, 2012 - Wound Care
July 11, 2012 - Women’s Health
August 8, 2012 - Fitness Medicine
September 12, 2012 - Neurology
October 10, 2012 - Patient Safety
November 14, 2012 - Diabetes

PERSONAL INFORMATION: Please complete the form below. The information you are about to submit is secure. (Bolded fields are required.)

I am registering as an:
Active Practicing Physician - $75
Retired Physician and Others - $50

Name and Degree (MD, DO, LMSW, etc):

Street Address:

City:

State:

Postal Code:

E-mail Address:

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CARDHOLDER INFORMATION:

Cardholder Name:

Billing address same as above

Billing Street Address:

Billing City:

Billing State:

Billing Postal Code:

Credit Card Number:

Expiration Date:

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Security code: (on back of card)

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