REGISTRATION FORM
MED ED Resources, Inc.
PO Box 1978
Crystal Lake, IL 60039-1978
815-479-0449

Name__________________________________________________ Home Address___________________________________________ City___________________State________Zip__________________ Home Phone(____)________________________________________ Organization_____________________________________________ Day time Phone(____)_____________________________________ Fax#___________________________________________________					Primary Clinical Focus A. Anteparturn B. L & D C. Postpartum D. Nursery E. NICU F. Mother / Baby G. LDR / LDRP H. Home Care I. Telemetry J. Office K. ICU L. PAR M. ER N. Student 0. Paramedic R Other__________
I Will Attend:
	Neonatal	Legal	EFM	EKG
Schaumburg, IL	03/01/99	03/02/99	03/03/99	xxxx
Milwaukee, Wl	03/10/99	03/11/99	03/12/99	04/19-20
Peoria, IL	03/23/99	03/24/99	03/25/99	5/6-7
Madison, Wl	03/29/99	03/30/99	03/31/99	4/26-27
Elgin, IL	xxxx	xxxx	xxxx	4/8-9

Combine Neonatal assessment, OB Legal Issues, & EFM Workshop to
meet your professional needs as a 1, 2, or 3 day seminar and SAVE!
EKG Interpretation is a 2 day course. EKG Interpretation can also be combined
with any other seminar to meet your professional needs.

PROGRAM FEES:

Method of Payment

$139 One Day

$259 Two Day Combination / or EKG

$369 Three Day Combination

$479 Four Day Combination

$550 Five Day Combination

Check or Money Order
Payable to: MED ED Resources, Inc.

Credit Card Payment

Visa

MasterCard

Card#___________________________________
___________________________________
Print Name of Card Holder
Expiration Date____________________________

Seating is limited. Registration with payment must be received 7 days prior to seminar date. All registrations received less than 7 days prior to the seminar date, must be registered via FAX #815-479-0449, complete with credit card information. At the door registration is based on seating availability. A $10 / day late fee will be added to the program fee.

Office Use Only
Received Date_____________________________

Purchase_________________________________

Paid By:_________________________________

Contact_________________________________