Registration Deadlines

January 31, 2012 for February 2012

*** The February course is now full and normal registration has been closed. Please contact Dr. Rowland (919-843-3546, pamela_rowland@med.unc.edu) for information regarding the waiting list or to discuss other options. ***

August 31, 2012, for September 2012

Enrollment for these courses is limited. Early registration is encouraged

Registration Fees

$2,800.00 for surgeons who have completed a residency

$1,600.00 for senior residents

Tuition includes education materials, digital video copy, refreshment breaks, and lunch on Day II and III.

If you are repeating the course and paid the full tuition, please contact Dr. Rowland (919-843-3546) for reduced fee information.

Late Fee

There is a $200 late fee charged for registrations made after deadlines

Cancellation Fee

There is a $500 cancellation fee

Payment

In addition to this form, please mail a check to the following address. Make checks payable to: Medical Communications

Please fill out this form to register for the course, and mail your check to the address listed above. Registration is on a first-come first-served basis.

*(denotes required field)

Name: *

E-Mail Address: *

Degrees Held *

MD
PhD
DO
Other (Please Specitfy)

Other Degrees Held

Affiliation *

Mobile Telephone *

Work Telephone

Mailing Address *

Course Date *

February 2012
September 2012

How many times have you taken the Certifying Examination? *

0 1 2 3 4 5+

Have you Ever Completed a remedial year? *

Yes
No
I am currently Enrolled in a remedial year
I am currently enrolled in an ABS Alternative Pathway

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