The Second Osler Symposium - October 19-24, 2012 in San Diego, CA

2nd OSLER SYMPOSIUM REGISTRATION

October 19–24, 2012

FOUR EASY WAYS TO REGISTER:

Online:
Complete the form below with your contact information and conference selections.
Items marked with a * are required. You will then continue on to a secure payment page.
Mail:
Click here to download the Registration Form PDF, complete the form and mail it with your payment to:
Osler Symposium Registration
Endorphin Power Company
509 Cardenas Drive SE
Albuquerque, NM 87108
Fax:
Click here to download the Registration Form PDF, complete it and fax to 505-266-3695
Phone:
505-506-4496

Comodo SSL-secured websiteONLINE REGISTRATION FORM  (this is a secure page)

First Registrant:
First Name: *
Last Name: *
Credentials:   
 
Second Registrant: (Couple's Registration)
First Name:   
Last Name:   
Credentials:   
 
Contact Information:
Mailing Address: *
City: *
State/Province: *
Zip/Postal Code: *
Country: *
Telephone: *
E-mail: *

SELECT CONFERENCE OPTIONS in Sections A, B, and C:

A. CONFERENCE
  No selection $0
  MD or DO $1445
  MD/DO & Spouse/Partner $1995
  Resident or Retired MD/DO $1195
  Resident/Retired & Spouse/Partner $1695
  All Others $995
  All Others & Spouse/Partner $1495

A.  Conference Registration Subtotal:  $ 
B. PRE- AND POST-CONFERENCE:
  Pre-Conference:
       –  No selection $0
       – “Yoga and Breathing”Khalsa $225
  Post-Conference:
       –  No selection $0
       – “The Healer Within...”Gage $195

B.  Pre- and Post-Conferences Subtotal:  $ 
C. GUEST TICKETS  (for NON-REGISTRANTS):
  Opening Dinner – ‘Grandma’s Beans’ – Sat, Oct. 20    #  tickets @$55 ea.
     (one ticket included in individual registration fee; two in couple's fee)
 
  Farewell Banquet/Lecture – Tuesday, Oct. 23             #  tickets @$70 ea.
     (one ticket included in individual registration fee; two in couple's fee)

C.  Guest Meal Tickets Subtotal:  $ 
TOTAL DUE:  $ 
D. PLEASE ANSWER THE FOLLOWING QUESTIONS:
  What is your specialty?  
  How did you first learn about 2nd Osler Symposium?  
  If you received brochure or postcard, what is the code on the first line?  

 

Please verify that Contact Information and Conference Selections above are correct.

***  You will proceed to a secure web page to complete your payment.  ***

Note that we ONLY accept MasterCard, Visa and Discover  We accept MasterCard, Visa and Discover Card

Your personal and credit card information will be encrypted and sent via a secure link for payment processing. We respect your privacy and will not use this information for any other purposes.

You will receive a receipt for your your online payment via email, and will also receive confirmation of your conference enrollment from the Endorphin Power Company.

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