Registration Form
UNIVERSITY OF MIAMI ANNUAL PATHOLOGY CONFERENCE
The W Hotel Miami Beach

January 21-25, 2019

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

Early Registration: On or before 9/30/2018
Regular Registration: Begins 10/1/2018

Registration fees are listed below.
Early Registration Fee
Regular Registration Fee
On Site Registration Fee
1.Practicing Physicians
2.Physicians in Active Duty Armed Forces, UM/JMH Alumni
3.Retired Physicians, Residents, Fellows, Pathology Assistants, and Laboratory Technologists






Registration includes participation in all general session lectures and workshops, educational materials, daily breakfast and coffee break, and social events.



Registration by Mail:

Please print the registration form and include it with payment. Checks and money orders should be made payable to University of Miami Pathology Department and mailed via secure mail (Federal Express, UPS) to the following address:

Alicia Cabrera
Clinical Program Manager
Bascom Palmer Eye Institute
900 NW 17 Street, Room 350
Miami, FL 33136
Office: 305-482-4364
Fax: 305-547-3674

CANCELLATION POLICY:

Refunds (less $75 cancellation fee) will be made ONLY if written notice of cancellation is received prior to December 21, 2018. After this date, NO REFUNDS WILL BE ISSUED. In cases where the course is cancelled due to an event of Force Majeure or insufficient registrations, a full tuition refund will be made. Refunds will be processed after completion of the conference.

For questions please feel free to contact Practical Advances in Pathology