Partners In Medical Education

2012 Spring Webinar Schedule - NEW

The Foundation for Effective Recruitment & Orientation

Registration Fee: Buy One, Get Second Half Off
$275.00 for 1st registrant; $412.50 for 2 registrants; $687.50 for 3 registrants; $825.00 for 4 registrants.

Please register all participants who are attending.

Three Ways to Register and Pay

1. Fax registration and pay by check or credit card (off-line)
Click here to access the PDF version of the registration form

2. Register on-line and pay by check
Complete the form below and click “Submit without Payment”
Mail check to:
Partners in Medical Education;
109 Brush Creek Road; Irwin, PA 15642
Note: We will invoice you if you choose this option

3. Register on-line and pay securely by credit card
Complete the form below and click “Pay On-Line”

Will you be using your Partners Telecourse Passport for this Telecourse?
If yes, please select the type of Passport you are using.

*Note to Individual Passport owners. If your session balance does not cover this telecourse, we will email you an invoice for the additional sessions at a special per-session fee.

Don’t have a Partners Telecourse Passport? Click here to learn more details.
and continue below with your registration

Institution Information

* Institution Name
* Address
* City:
* State:
* Zip:
* Date of next site visit (Institution or Program)”
If not an institutional review, please list specific program
* How did you hear about this telecourse?	Email flyer Fax Flyer Personal Email Colleague Other

Registrant 1

Registrant 2

* First Name:
* Last Name:
Degree:
Position/ Title:
*Residency or GME/Hospital Dept:
* Phone:
Fax:
* Email:
# Years in GME	:
Date of next site visit (Institution or Program)
If not an institutional review, please list specific program
	Ok to share contact information Yes No
	*(required for registration confirmation)

* First Name:
* Last Name:
Degree:
Position/ Title:
*Residency or GME/Hospital Dept::
* Phone:
Fax:
* Email:
# Years in GME:
Date of next site visit (Institution or Program)
If not an institutional review, please list specific program
	Ok to share contact information Yes No
	*(required for registration confirmation)

Registrant 3

Registrant 4

* First Name:
* Last Name:
Degree:
Position/ Title:
*Residency or GME/Hospital Dept:
* Phone:
Fax:
* Email:
# Years in GME	:
Date of next site visit (Institution or Program)
If not an institutional review, please list specific program
	Ok to share contact information Yes No
	*(required for registration confirmation)

* First Name:
* Last Name:
Degree:
Position/ Title:
*Residency or GME/Hospital Dept:
* Phone:
Fax:
* Email:
Date of next site visit (Institution or Program)
If not an institutional review, please list specific program
# Years in GME	:
	Ok to share contact information Yes No
	*(required for registration confirmation)

If you have more than 4 people to register, please complete a second registration form.

Cancellation Policy: Cancellations made within three (3) business days of the course are subject to a $50 service fee. Registrants who do not dial in and who do not cancel before the conference date are liable for the full telecourse fee. Only written requests for cancellation will be accepted. Cancellations must be made by fax at 724-864-6153 or by email (info@PartnersInMedEd.com).

“Using Partners in Medical Education for preparation of an upcoming Institutional Site Visit was the best resource that I could have ever asked for.”

DIO from Greater Washington DC Area

Helpful GME Calendars
2012 Medical Education Calendar – NEW!
2012 Spring Webinar Schedule - NEW

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