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A Family Medicine Forum
Procedure Clinic & Residency Fair

  Date:           Saturday, October 25, 2008

Time:            9:00 a.m. – 3:00 p.m.

       Place:         Northwestern University-Lurie Building - 303 E Superior, Chicago

·        Residency fair with more than 30 family medicine residency programs

·        Demonstrations and workshops on a variety of topics.  Past topics have included: intubation, IUD/diaphragm, suturing, OB ultrasound, EKG, casting/splinting, family genograms, joint injections, and more!  

The $15 registration fee includes lunch and participation in the workshops, demonstrations, and exhibits.  This event is being co-sponsored by Northwestern University’s Department of Family Medicine, so the registration fee for Northwestern students is just $5 (*You must present your student ID at the event).  Cancellations must be received by Friday, October 17th in order to receive a refund.

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Name:                                                                                                                            

School:                                                                  Year of Graduation:                           

Address:                                                                                                                        

                                                                                                                                      

Phone:                                                         E-mail:                                                        

 

Credit Card:           Visa             MasterCard            American Express

 

                                                                                                                                     

Card Number                                                                            Exp. Date

                                                                                                                                     

Signature                                                                                  Date

 

ONLINE REGISTRATION WILL ALSO BE AVAILABLE.  Contact our office for more information.  Please make your check or money order payable to “IAFP Foundation” and send it with this registration form to:

IAFP Foundation, 4756 Main Street , Lisle , IL 60532

Contact our office at 800-826-7944 with any questions!

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