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Yes,
I want to attend the KCMSMA
Meeting Wed Oct 27th 2010
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Where:
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When:
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Cost:
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11400 Tomahawk Creek Parkway
Leawood, KS 66211-2680 |
Wed Feb 23, 2011 8:30
AM – 10:00 AM
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$25.00 for MSMA
members
$35 For non-members
$10 for Guest |
Simply
fill out this form and print it using the print button at the
bottom and mail it in with your check or money order, or you
may submit it electronically and we will bill you directly through
the mail.
Please
complete the KC MSMA Registration Form below and send
to:
Diane Chastain
AAFP
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2680
Fax Number 913 906-6388
Make
check payable to Kansas City KCMSMA.
OR
Fill the
form below & make payment useing PayPal with any major credit
card.
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| Registration
Information: |
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fields in bold) |
| Name: |
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| Company
Name: |
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| Street
Address: |
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| City: |
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| State: |
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| Zip
Code: |
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| Phone: |
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| Fax: |
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| Email: |
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| Number
Attending: |
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| MSMA
Member?: |
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Additional
Comments?
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After Clicking the submit button you will have the option of
using PayPal
Credit card users will be charged a small processing fee.
If you have questions please call or email
Diane
Chastain
Phone: 913-906-6292 |
