REGISTRATION FORM
Intraoperative Neurophysiological Monitoring in Neurosurgery (please
print and send it by fax 212-8709690).

Name..................................................
Address...............................................
City...........................State..........Zip.....
E-Mail and/or fax number..............................
Business telephone....................................
Affiliation...........................................
Specialty............................
Registration fee: 300 USD for practicing physicians
                  250 USD for resident, fellows,nurses,
                          PA's, technicians.
Payment by check ___ 
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Please make checks payable to Beth Israel Medical Center.