Registration Fee $695/meeting
(by January 26, 2010)
Fee Increases to $795/meeting
after January 26, 2010

Registration Fee for Both Meetings is $999
Increases to $1199 after January 26, 2010

Name:___________________________________OD  MD  DO
Address:____________________________________________
City/State/Zip:_______________________________________
Phone:______________________________________________

email:_______________________________________________

Please print this and mail completed registration form, along with payment, to:

CE in Italy
c/o Dr. James Fanelli
5311 S. College Rd
Wilmington, NC  28412
910-452-7225

PLEASE SPECIFY WHICH CONFERENCE I AM PLANNING ON ATTENDING:

____ Rome 12 Hours    ____ Cinque Terre 12 Hours    ____ Both Meetings