OREGON BONES SPRING CONFERENCE
All Staff Event
April 19, 20 2007
REGISTRATION FORM
Name_______________________________________________________________
Clinic _______________________________________________________________
Title_________________________________________________________________
Address______________________________________________________________
City/State/Zip__________________________________________________________
Phone Number_________________________________________________________
E-Mail________________________________________________________________
2007 Bones Membership ( per calendar year - $100 per Admin/Manager; $50 per Ancillary staff person)
You may include appropriate “membership fee” with conference registration if not previously sent.
Registration Fees: (circle appropriate fee for each attendee)
$200.00 Bones Member, 1st registration (named above)
$150.00 Bones Member, 2nd & 3rd registration (each)
(2)______________________________________ (3)_________________________________________
$100.00 Bones Member, 4th, 5th or more registration (each)
(4)______________________________________ (5)_________________________________________
$300.00 Non-Bones Member
Please submit this registration form & fee to :
Tona Springer – Secretary-Treasurer
C/o Cascade Orthopedics & Sports Medicine Center, PC
1715 E. 12th Street
The Dalles, OR 97058
Questions: Please call 541-296-2294 or E-Mail tonas@cosmc.com
MEETING LOCATION
Hotel deLuxe
729 SW 15th Ave. Portland OR
Reservations: 503-219-2094
** Mention that you are a BONES Conference Attendee for the $129 room rate**
REGISTRATION MUST BE RECEIVED BY April 1, 2007
Do you plan on attending Thursday night Board Meeting? YES NO