CURRENT TOPICS IN WOMEN’S HEALTH CARE & ALSO® REFRESHER COURSE • APRIL 29–30, 2016 REGISTRATION You may register for Current Topics in Women’s Health Care, the ALSO® Refresher Course, or both.
Current Topics in Women’s Health Care Circle Your Friday Workshop choice: ALSO® Refresher Course
OAFP Member
Out-ofstate AAFP Member
NonMember
Allied Professional
$200
$250
$300
$150
Nexplanon Insertion Training $400
$450
Total
Diabetes in Pregnancy $500
$350
Your Registration Total Please note there is a $25 cancellation fee
Your Name Office Street Address City
State
Email
ZIP Phone
State License/ME# (if taking Nexoplan Insertion Training)
Register in one of these ways: • Use our secure website at www.oafp.org/events/ • Fax this completed form to 503.528.0996 • Mail this completed form to Oregon Academy of Family Physicians 1717 NE 42nd Ave., Suite 2103 Portland, OR 97213 Make checks payable to the Oregon Academy of Family Physicians. If using a credit card, complete the information below as we cannot charge your credit card without your signature. VISA/MC #
Expiration Date
Signature For questions and more information, contact Kerry Gonzales, OAFP Executive Director 503.528.0961 •
[email protected]
Current Topics in Women’s Health Care & ALSO® Refresher Course Providence Milwaukie Family Medicine Residency 10150 SE 32nd Ave., Milwaukie, OR 97222
