Catholic Medical Association



To register for the conference, please complete and submit this online form OR click here for a print-friendly version. If registering more than one participant, feel free to send one check but print and complete a separate form for each participant. Thank you. * denotes required field
* Name:
Title:
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CME Credit Requested:	Yes No	Type of Credit:
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Spouse/Guest Name:


FULL CONFERENCE PACKAGE
Includes Registration, Breakfast and Lunch, and Saturday Banquet
Number	CMA Members	Price
	Physicians and Dentists	$690
	CMA Member Spouses, Priests, Religious, Medical Students, Allied Health Professionals, General Public	$435
	Non-CMA Members
	Physicians and Dentists	$745
	Non-CMA Member Spouses, Priests, Religious, Medical Students, Allied Health Professionals, General Public	$460

SINGLE DAY REGISTRATION
Includes Registration, Breakfast, and Lunch
Number		Price
	Physicians and Dentists	$370
	All Others	$245

AN EVENING AT THE GEORGIA AQUARIUM
Must pre-register. Includes Transportation to and from the Conference Hotel, Private Tour, Reception, and Dinner
Number		Price
	Adults Guest(s) Name:	$95
	Children 12 and under Guest(s) Name:	$75

EXTRA TICKETS TO SATURDAY EVENING BANQUET
This is only for EXTRA TICKETS, as it is already included in our Full Conference Package.
Number		Price
	Extra Tickets for the Saturday Evening Banquet Guest(s) Name:	$95

DONATION OPPORTUNITIES

		Price
	I would like to be a conference sponsor with a tax-deductible donation of: $
	I would like to sponsor scholarships with a tax-deductible donation of: $
	I would like to support the CMA Medical Missions a tax-deductible gift of: $

2007 MEMBERSHIP DUES

		Price
	Please include my 2007 membership dues (click here for chart) : $

Total Paid

		Price
* Please insert your Total Amount: $
Refund Policy: A refund will be given if notification is received in writing on or before September 1, 2007 minus a $75 administrative charge. Sorry, no refunds after September 1, 2007. No exceptions.

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Comments, additional information or questions:

The CMA uses Secure Sockets Layer technology to allow for encryption of personal and billing information transmitted over the internet.

Have a question or need more information? Call the CMA at (215) 877-9099 or e-mail info@cathmed.org. If paying by check, please make your check payable to Catholic Medical Association and mail with your completed form to:

Catholic Medical Association
333 E. Lancaster Avenue, #348
Wynnewood, PA 19096-1929

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