OB-GYN Courses Registration Form

Note: First and Last Name, plus eMail address are required for this form to work.

Registration Form

Last Name
First Name
Address
City
State	Zip
PH: Work
PH: Home
Fax: Work
Fax: Home
eMail
Occupation
Degrees
WH Experience
Prior WH Courses

3-day OB course Instructor Training in Pre/Postnatal Exercise: $650
First choice
2nd Choice
	(Within 21 days of the course: $695)

2-day GYN course Women's Health: What Every Health Care Providers Should Know: $450
First choice
2nd Choice
	(Within 21 days of the course: $495)

Take both courses for 10% Discount: $990 total

The registration fee includes whole foods each day including lunch. Due to the demand for these small training programs, places cannot be reserved without payment. You can hold a place, for example, while awaiting processing of the check by your facility, by sending a personal check for $l00, or you may use Mastercard/Visa. Cancellation Charge: $100. Return check charge: $50. Sorry, no refunds for cancellations within 21 days of the course; transfer to a future course with no time limit. Information on accommodation and directions to the course location will be sent and is available via links on the SCHEDULE page.

M/CARDVISA AMEX
Exp. Date

	Please make check payable to: Elizabeth Noble 448 Pleasant Lake Avenue, Harwich, MA 02645

Please complete:
	I am pregnant
	I am bringing an infant aged weeks
	I would like information on accommodation
	I prefer to share accommodation. Please give my name to other participants.
	How did you hear about this course?
	PT Bulletin Online:
	Advance for PTs:
	Other journal:
	Direct Mail:
	Friend:
	Internet:
	Other:

	Comments:

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