Follow the four simple steps below to register online. * indicates required fields.

Please keep this form as confirmation of your registration - no other confirmation will be generated or sent.

Please note:
San Luis Obispo attendees:
Non-members attending the September 23, San Luis Obispo event will need to send a $100 registration fee made payable to "San Luis Obispo County Medical Association" and mail to the following address:
SLOCMA
P.O. Box 4826
San Luis Obispo, CA 93403

Manatee County Medical Society attendees:
Non-members attending the October 1, Manatee County Medical Society event will need to send a $42 registration fee made payable to "San Luis Obispo County Medical Association" and mail to the following address:
SLOCMA
P.O. Box 4826
San Luis Obispo, CA 93403

Date & Location

Please select the event you would like to attend:*

--None-- September 23, 2009, San Luis Obispo, CA October 1, 2009, Bradenton, FL October 27, 2009, Orange County, CA

Describe Your Practice

Number of Physicians:*

Timeframe to select an EHR system:* --None-- 1 to 6 months 6 to 12 months Just beginning to research None of the Above

Include Your Contact Information

Name of Practice:*

Address: *

City:*

State:*

Zip:*

PRIMARY CONTACT

First Name:*

Last Name:*

Title:*

Contact Phone:*

Fax:

Contact Email:*

List Who Will Be Attending

Attendees:*

(Please enter name, title, name, title, etc.)