Course Registration

* Registration not Confirmed until full payment is received
Please use the form below to register online

Name
Address
City
State
Zip
Phone
Cell Phone  
Fax
Medical License#
Medical Specialty  
Email Address  
Course Name
Course Date
Accompanying Staff (Name & Title)  
  *Preceptors may offer additional training (additional fees required & spaces are limited)
Supplemental Training  
  *Fees may apply and space is limited
Comments
  Cancellation Policy: Registration is 90% refundable if a written cancellation is received 2 weeks prior to the scheduled workshop.
 Course dates & times subject to change.

Click here to download the registration form and fax it to 520.545.1254
If paying by check, send completed form & check to:
FAME (Foundation for the Advancement of Medical Education)
8000 S Kolb Rd, Ste 104
Tucson, AZ 85756