PES 2018 Clinical Update Course
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First Name:
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Last Name:
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Degrees
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Institution/Organization
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Address:
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City:
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State/Province:
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Country:
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Zip/Postal Code:
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Business Phone:
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E-mail:
Are you a Pediatric Endocrinologist?
Yes
No
If Yes, in:
Private Practice
Academic Research
Academic Clinical (more than three-half days of patients per week)
Are you an Adult Endocrinologist?
Yes
No
Other:
Are you taking the course predominantly to:
Get an update
Prepare for the Boards
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Method of Payment:
Credit Card (MasterCard/Visa only)
Total Amount: U.S.
$300.00