SEAK, Inc. Hyannis July 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 payment to:   SEAK, Inc. PO Box 729, Falmouth, MA 02541
                                                                                                                                    priority code: web

                                                             Please register me for:
MAIN CONFERENCE

___26th Annual Workers’ Compensation and Occupational Medicine Seminar ($895:July 18-20, 2006)

PRECONFERENCES

___ Workers' Compensation Legal Issues and Defense Strategies ($395:July 17, 2006)
___ ADA, FMLA, and Workers' Compensation:  In Depth ($395:July 17, 2006)
___ Injured and Aging Workers: Maximizing the Fit Between Worker and Work ($395:July 17, 2006)
___ Comprehensive Assessment and Treatment of Chronic Pain ($395:July 17, 2006)
___ Practical Ergonomics for Employers ($395:July 17, 2006)
___ OSHA for Occupational Health Professionals ($395:July 17, 2006)
___ Return to Work: Creating Momentum in the Work Restoration Process ($395:July 17, 2006)

I would like to apply for the following credits (Please check as many as are applicable):

__Attorney (LAWYERS ONLY)        __Case Manager        __Disability Specialist            __MD/DO
         __ Occupational Health Nurse             __ Rehabilitation Counselor            __Nurses

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