NPMA 2007 Conference Registration Form

Hotel Reservations
Westin Casuarina Hotel, Casino and Spa
160 E. Flamingo Road
Las Vegas, NV 89109
1-702-836-9775

Rate:
$129.00 single/double accommodations
Reservations must be made After July 2, 2007.
Make your reservation on line!

DPM REGISTRATION


Fees  
Select the type of registration
NPMA Member    # of Regs
 $300/person    After 7/1/07   
NON-MEMBER    # of Regs
 $700/person    After 7/1/07   
PODIATRY STUDENT/RESIDENT/RETIRED    # of Regs
 $75/person    After 7/1/07   
PODIATRY RESIDENT    # of Regs
 $75/person    After 7/1/07   
RETIRED PRACTIONER    # of Regs
 $75/person    After 7/1/07   
Spouse/Guest?     Yes     No
Number of Children  


DPM Information


DPM's Name:
NPMA Member?     Yes     No
Street Address:
City:
State:    Zip/Postal Code:
Business Phone:  Fax:


Payment Options


Email Address:
Select One:   
Amount:
Name on Card:
Card Number:
Expiration Date:
Comments:


Questions? Need more information?
Call us at 773.374.5300 or e-mail: NPMADebby@sbcglobal.net