SEAK, Inc. Cape Cod, August 2006 REGISTRATION FORM

To register, call SEAK, Inc. at 508-457-1111, or Print this form and complete the requested information (neatly, please), and FAX to SEAK, Inc. at 508-540-8304, with credit card information.  Or mail with credit card information or check to: SEAK, Inc. P.O. Box 729, Falmouth, MA 02541

priority code: web

Please register me for:
___How to Start and Build a Successful Expert Witness Practice ($495) Cape Cod August 16, 2006

___Medical Malpractice Survival Training ($495) Cape Cod August 16, 2006

___How to Be an Effective Medical Witness ($995) Cape Cod August 17-18, 2006

___Legal Liability Prevention for Physicians: 2006 ($1,195) Cape Cod August 17-18, 2006

___Non-Clinical Careers for Physicians ($1,195) Cape Cod August 19-20, 2006

___2006 IME Summit ($1,195) Cape Cod August 19-20, 2006

$_______ Amount Enclosed 

Payment Info
 Please print or type all information. Use abbreviations as necessary.

 □ I'm paying by credit card  or  Check Enclosed (made out to SEAK, Inc.)  □
 Type of card: ___Visa ___MC ___AmEx  Exp. Date:       
 Credit Card #:
 
 Name
 Name of Organization
 Address
 City                                                                  State                        Zip
 Phone                                                                Fax
 E-Mail
 Specialty

SEAK, Inc. FAX  (508) 540-8304