CI24 - Order Form - Promedica International CME

Attendee Information (if different from Credit Card Holder/Payee)
Note: Confirmation and related correspondence will be sent to the address listed here.

Salutation*

Name*

First Last

Email*

Qualifications

Attendee’s Specialty*

Phone*

Fax

Company/Hospital

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Attendees Names

If you are registering more than one attendee through this form, please list the attendee names here. If you are only registering yourself, please leave this field blank.

Comments

Do you have any special needs you would like us to be aware of?

Check here if you require vegetarian meals

Yes, I require vegetarian meals

Permission to include your information on the symposium attendee list

Do you give permission to the Cardiovascular Interventions symposium to share your name and contact information (address only, no attendee emails will ever be shared) with sponsoring companies as part of a symposium attendee list?

Yes, I give my permission
No, I do not give my permission

How did you hear about this symposium?*

If "other" please describe

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Comments

This field is for validation purposes and should be left unchanged.

35th Annual Cardiovascular Interventions

Secure Online Registration

Registration Categories

35th Annual Cardiovascular Interventions
November 12-15, 2024

Optional Satellite Symposia Registration

35th Annual Cardiovascular Interventions

Secure Online Registration

Registration Categories

35th Annual Cardiovascular InterventionsNovember 12-15, 2024

Optional Satellite Symposia Registration

35th Annual Cardiovascular Interventions
November 12-15, 2024