Bethesda Maryland Spine Workshop Walter Reed Medical Center For Civilian and Military Doctors

20TH ANNUAL INTERNATIONAL BETHESDA SPINE WORKSHOP

8120 Wisconsin Avenue, Bethesda, Maryland 20814
Direct Hotel Reservation:
(301) 652-2000
Reservations Deadline:
March 7, 2008

REGISTRATION:

Name
Street Address
City
State
Zip Code
Work Telephone
Home Telephone
Fax Number
Email
Military Rank
Duty Station/Location
Specialty
Scrub Size:
HENRY M. JACKSON FOUNDATION *Please return Registration Fees and form to:
GENE EVANS, Program Coordinator 2216 Sandalwood Rd • Va Beach, VA 23451 Telephone (757) 496-5742 • Fax (757) 496-4983

Please indicate the Course you wish to attend:

CERVICAL COURSE - April 11-12, 2008

Civilian Course Fee - $2,100.00*
Civilian Resident/Fellow Course Fee - $1,050.00*
US Military Course Fee (AD/RESV/RES) - $1,050.00*
Federal Civilian/VA Course Fee - $1,050.00*
US Retired Military Course Fee - $1,200.00*
Foreign Military (Active Duty) Course Fee - $1,200.00*

THORACO-LUMBAR COURSE -April 13-14, 2008

PERIPHERAL NERVE COURSE - April 15-16, 2008

Civilian Course Fee - $1,400.00*
Civilian Resident/Fellow Course Fee - $700.00*
US Military Course Fee (AD/RESV/RES) - $700.00*
Federal Civilian/VA Course Fee - $700.00*
US Retired Military Course Fee - $850.00*
Foreign Military (Active Duty) Course Fee - $850.00*

HOW DID YOU FIND OUT ABOUT THIS PROGRAM?

If Other, Where?

* Add $200.00 to any Registration made after March 10, 2008

Return Registration To:

FOR FOR MORE INFORMATION, CONTACT:)
GENE EVANS, Program Coordinator
2216 Sandalwood Rd • Va Beach, VA 23451
Telephone (757) 496-5742 • Fax (757) 496-4983
E-Mail: geneevans@erols.com
www.bethesdaspine.com

Please make Registration Fee payable to:

HENRY M. JACKSON FOUNDATION

Notice of Cancellation and Refund Request by registrant must be received in writing by March 10, 2008. No refunds will be made after that date. A two hundred dollar ($200.00) Administrative Fee will be charged for refunds requested.