Registration - 30th Residency Reunion

NAME:
STREET or PO ADDRESS:
CITY:
STATE:
ZIP:
E-MAIL:
TELEPHONE: HOME #
TELEPHONE: WORK #
TELEPHONE: CELL #
 
I will attend CME on (check one below)
(Includes two tickets to dinner at Kora) :

Friday and Saturday (8/15-8/16)   
Friday (8/15) only
Saturday (8/16) only
I will attend Friday evening dinner at Davinci's:

Graduate Attending (paid by FMRP)  
Spouse/Partner - $5.00
Children over 5 - $2.00
Children under 5 - free
   
I will attend the Saturday evening dinner and dance at the Kora Temple, $25 per adult if you did not attend any of the CME events, please check appropriately.
 
Adults attending
Children (eating)

Attended CME Did not attend CME
 

Fee Schedule for the CME Events (includes two tickets to dinner at the Kora)
Reply by:
July 14
July 25
At the Door
MD/DO
$175/$100
$200/$125
$250/$175
NP/Allied Professional
$125/$75
$150/$90
$200/$140

Once you submit the registration, you will receive a confirmation and a total amount to send to us. Sorry, we are only able to accept checks.

If you do not receive confirmation of this registration, please contact Jill Freda at 207-795-2803 or e-mail: fredaji@cmhc.org

   






Events Schedule Lodging On-line Registration