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Genetics in Primary Care

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Genetics in Primary Care
Genetics in Primary Care:

A Brown-Oxford Transatlantic Videoconference

REGISTRATION FORM



Date: April 10, 2003

Time: 8 am – 2 pm EST (Providence) / 1 pm – 7 pm GMT (London)

Locations: (1) George Auditorium, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02905, USA*

(2) Cancer Research UK Video Conference Facility, 6-10 Cambridge Terrace, London, NW14JL, UK**





This conference is funded by National Cancer Institute grant #1 R13 CA101634-01,

The Brown University Center for Primary Care and Prevention,

and by Memorial Hospital of Rhode Island.

Please complete the fields below and forward with registration fee to:

Dr. Sean P. David

Genetics Conference

Brown University Center for Primary Care & Prevention

111 Brewster Street, Pawtucket, RI, 02860, USA

Fax #: (401) 729-2494 (if paying by credit card)



Title: __Dr __Prof __Mr __Mrs __Ms



First Name: Position:



Last Name: Organization:



Address:







Telephone #: Email:



Fax #:





Registration Fee Payment Method:

__Check __Credit Card

(please make checks payable to

Brown University Center for Primary Care & Prevention) CC Type: __Master Card __Visa



REGISTRATION FEE: $25.00 (US) Credit Card #:



*Memorial Hospital of Rhode Island is accredited by the Rhode Island Expiration

Medical Society to sponsor intrastate continuing medical education for Date:

physicians. Memorial Hospital of Rhode Island designates this

educational activity for a maximum of six (6) Category I credits

towards the American Medical Association Physician's Recognition Payment

Award. Each physician should claim only those hours of credit that Amount:

he/she actually spent in the educational experience.

Cardholder’s

**PGEA Approved Signature:


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