~~~ Registration Form ~~~
(please print)

2007 Eastern Iowa Heart Symposium, Cedar Rapids, IA
October 27, 2007

Name _____________________________________________________

Designation   ___ MD   ___ DO     ___ PA     ___ ARNP     ___ RN     Other________________

Practice/Hospital ________________________________________________________________

Address _______________________________________________________________________

City___________________________________ State ____________Zip___________________

Phone: __________________________________

 Please mark the appropriate box for education credits:
 ___ CME     ___ CEU   Nursing License # (if applicable) _____________                            

~~ Registration Fee ~~

Physicians/Physician Assistants $100.00
Residents, ARNP, RN, LPN, CMA, Others $45.00
$10.00 surcharge for on-site registration
(includes course materials, continental breakfast, lunch and refreshments)
 

Make Checks payable to:
Iowa Cardiology Education Association
Mail payment along with registration form to:
Iowa Cardiology Education Association
Attn: Brenda Lansing
1002 Fourth Avenue, SE
Cedar Rapids, IA 52403

For Symposium and registration inquiries,
call Brenda Lansing at 319-739-2001

~~ Registration Deadline and Cancellation Policy ~~
The deadline for the course registration is October 19, 2007. A full refund of registration is available if the cancellation notice is received in writing by October 19, 2007.  There will be no refunds issued after this date.