Sheraton New York Hotel and Towers, New York, New York, December 8-10, 2005

Name: Degree:

Address:

City State Zip Code:

Daytime Phone:( ) Fax:()

E-mail:

Registration Fees: (Please check)
Practicing Physicians $795
Resident and Fellows $350 (Letter of verification from Chief of Service required)

Reception: (Please Check)
Museum of Art and Design
Thursday, December 8, 2005, 6:30 – 8:00pm
I will will not attend the reception.

Luncheon
A guest will join me on Thursday, December 8, 2005 $65.00

Enclosed is my check payable to Continuing Medical Education
Or charge my Visa MasterCard AMEX
Card # Exp. Date
Signature

Four Easy Ways to Register:

Mail this form with your check, Visa, MasterCard or American Express number to:

Center for Continuing Medical Education
Albert Einstein College of Medicine
3301 Bainbridge Avenue
Bronx, New York 10467

Fax this form with your Visa, MasterCard or American Express number to:
718-798-2336.

Phone 1-800-575-4331 with your Visa, MasterCard or American Express number