Conference Registration Form
June 11-14, 2018 • Destin, Florida
Registration badges will be required for admission to all events. Payment is due with registration form and must be submitted according to the above dates to qualify for the corresponding rate. Materials can only be guaranteed to pre-registered attendees – be sure to register early.
Please complete and submit the registration form below. One registration form per person. If you prefer, you may print this form with your browser and fax or mail to Skin, Bones, Hearts & Private Parts.
In accordance with the Americas with Disabilities Act, please notify the Skin, Bones, Hearts & Private Parts office if you have any special needs.
Written notice of cancellation must be received by June 9, 2018. A $75 administrative fee will be retained. For a detailed look at the refund policy, please click here.
MAIL OR FAX INSTRUCTIONS:
If paying by credit card, please be sure to include all credit card information, including credit card number and billing zip code.
|Complete form and mail to:||Skin, Bones, Hearts & Private Parts
1905 Woodstock Road, Suite 2150
Roswell, GA 30075
|Complete form and fax to:||770-640-1095|
Payment is due with registration form and must be postmarked/submitted by the above dates to qualify for corresponding rate. To avoid duplicate charges, do not mail original registration form if you have already faxed it or submitted it via this webform.
|Make checks payable to DMGCME||DMG’s Federal Tax ID#: 58-2582200|
In accordance with the Americans With Disabilities Act, please notify the Skin, Bones, Hearts & Private Parts office if you have any special needs.