Rios Associates

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Registration
 

Home
Modules
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Registration
Accreditation

 

Name  

Address  

City, State, Zip 

Telephone 

Fax 

Email address

Mailing address for materials (if not the same as above)

Address 

City, State, Zip

 

Please, register me for your Webminar and mail the

   Material to the above address                                          $249  

Shipping and handling     (Express Mail)                                 $ 34

I have the material or have already registered

Please register me for the following module(s).  Each module has 15 Category 1 AMA CMEs

Module 1-__                                                               $99

Module 2-__                                                               $99

Module 3-__                                                               $99

Module 4-__                                                               $99

Module 5-__                                                               $99

Culture Sensitivity Session on __/___/____                   $49

 

TOTAL                                                              $________

 

Please print and mail with your check to:

 Rios Associates, 3729 N. Bay Horse Loop, Tucson, AZ 85719           

-Or -

Bill my Credit Card:           0  VISA   –   0  MasterCard

Name on Card _________________________________

Billing Address ________________________________

            ____________________, _____, ____________

Card #: ______________________________________

Expiration Date: ___/___/________     CVC #  ________

Information Request Form

Select the items that apply, and then let us know how to contact you.

  I want to register
Send more information
Have a person contact me

Name
Title
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E-mail
Phone

 

 

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Last modified: 08/16/08