Registration Fee $695/meeting
(by December 31, 2011)
Fee Increases to $795/meeting
after January 1, 2012

Registration Fee for Both Spring or Both Fall Meetings is $999
Increases to $1199 after January 1, 2012

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
5526-B Carolina Beach Rd
Wilmington, NC  28412
910-452-7225

PLEASE SPECIFY WHICH CONFERENCE YOU ARE PLANNING ON ATTENDING:

____ Spring Cinque Terre 12 Hours    ____ Spring Castiglion Fiorentino 12 Hours   
 ____ Both Spring Meetings 24 Hours


    ____Fall Florence Meeting 12 Hours  ____Fall Castiglion Fiorentino 12 Hours
____Both Fall Meetings 24 Hours