REGISTRATION - IMPACT 2012
Please indicate which meeting you wish to register for by marking the appropriate box below.
Please fill out the form below and click the SUBMIT button to register.
You will receive a confirmation email within 24 hours.
*
indicates required field.
Name:
Prefix
First
*
Last
*
Suffix
Degree:
*
Specialty:
*
Address:
Street
*
City
*
State
*
Zip Code
*
Work Phone #:
Fax #:
Email Address:
*
FOR HOTEL INFORMATION
AND RESERVATIONS CONTACT:
Brandon Koenig
Impact Housing Coodinator
847-808-1818
Brandon@meetingsolutions.us
Should you have any questions, please call us at (866) 942-6277.
*Advance registration is highly recommended. Onsite registration will be accepted on a space-available basis.
Produced by Digestive Diseases Education Company, Chicago, Illinois.
Copyright © 2012 by Digestive Diseases Education Company
