Link to printable version of the Registration Form: Registration form 9-5-07.doc
OREGON BONES FALL CONFERENCE
November 8-9, 2007
REGISTRATION FORM
Name____________________________________________________
Clinic ___________________________________________________
Title_____________________________________________________
Address__________________________________________________
City/State/Zip_____________________________________________
Phone Number____________________________________________
E-Mail__________________________________________________
2007 Oregon 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)
$150.00 Oregon Bones Member (paid), Manager (named above)
$ 75.00 Oregon Bones Member (paid), each additional Manager
(2)____________________________________ (3)_____________________________________
$100.00 Oregon Bones Member, (paid), each Non-Manager Staff person
(1)_____________________________________(2)_______________________________________
$200.00 Non-Oregon 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
Salishan Spa & Golf Resort
7760 Highway 101 North
Gleneden Beach, OR 97388
Reservations: 1-800-452-2300
** Oregon BONES Conference Attendee Group Rate is $130 **
REGISTRATION MUST BE RECEIVED BY October 31, 2007
Do you plan on attending Thursday night Social Event? YES NO Guest? YES NO__