CEDH USA





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Registration Form:

To register, please complete the form below and submit. A CEDH representative will contact you to arrange payment. You may also download our brochure, print and complete the registration page and mail or fax to CEDH.

First Name

Last Name

Credentials

License Number

Specialty

Title

Office/Institution

Business Address

City	State	Zip

Office Phone

Office Fax

E-mail

Hospital
Other Affiliation

Registration Fees
$2,000 - 136 hours of training and all course materials

$1,400 - 136 hours of training and all course materials (if registered by October 15, 2007)

$500 - Current medical students, 136 hours of training and all course materials (please supply copy of student ID)

Location

Payment - we accept checks, Visa, MasterCard and American Express. A CEDH representative will contact you to arrange payment.