To register via mail or email using a Microsoft Word document rather than this Web form, please use the Phoenix Registration Word Document.

Annual Conference 2005 - Phoenix, AZ

ANMF Ninth Annual Conference
June 17-18, 2005

Hilton Suites Phoenix
10 East Thomas Road
Phoenix, Arizona
 

Registration Form

Name: First ______________________ Middle ___________________ Last _____________________________

Title: _______________________________________________________________________________________

Institution: __________________________________________________________________________________

Mailing Address:

Mailing Address:

Street Address _________________________________________________________________________

City______________________________________________ State______________ Zip Code__________

Telephone  (         )  __ __ __ - __ __ __ __        Email_________________________________________

Name of spouse or partner attending conference: _____________________________

Registration fee:

		Alone		With spouse/partner
Medical doctors, dentists, etc.		$100		$150
Medical doctors doing residency		$50		$75
All others except students		$50		$75
Students		$30		$45

Please make check or money order payable to America Nepal Medical Foundation and mail it with your registration form to:

America Nepal Medical Foundation
2743 South Veterans Pkwy, PMB#302
Springfield, IL 62704 USA

Please fill out the registration form and mail it before May 23, 2005

Venue:   

Hilton Suites Phoenix
10 East Thomas Road
Phoenix, AZ 85012
602.212.5320

Accommodations:

Hilton Suites Phoenix
10 East Thomas Road
Phoenix, AZ 85012
(602) 222-1111 or (800) 445-8667

$79.00 single/double net rate special for ANMF Conference Attendees

For more information, please contact:

Brendan Thomson, MD, ConferenceCoordinatoranmf.net

Julia Shepardson, ExecutiveDirectoranmf.net