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

Annual Conference 2006 - New

ANMF Tenth Annual Conference
June 16-18, 2006

Newark Liberty International Airport Marriott
Newark, New Jersey
 

ANMF in the 2nd Decade: Supporting Healthcare in Rural Nepal

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:

		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 this registration form and mail it before May 20, 2006

Venue:   

Newark Liberty International Airport Marriott
Newark International Airport
Newark, New Jersey 07114 USA
Phone: 1-973-623-0006
Fax: 1-973-623-7618
Sales: 1-973-623-0006
Toll-Free: 1-800-882-1037

Accommodations:

Newark Liberty International Airport Marriott
Newark International Airport
Newark, New Jersey 07114 USA
Phone: 1-973-623-0006
Fax: 1-973-623-7618
Sales: 1-973-623-0006
Toll-Free: 1-800-882-1037

Special rate for ANMF Conference attendees for reservations made by June 6, 2006 - single/double $99.00 plus applicable state and local taxes, currently 13%, in effect at the time of check in. Only a limited number of rooms are available at this rate, so please make your reservations early.

For more information, please contact:

Rekha Hamal, MD, Conferenceanmf.net
Janak Koirala, MD, MPH, Chairanmf.net