Gastroenterology & Hepatology

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Liver Disease Update - Registration

Please complete the following fields as you would like them to appear on the CME/contact hour certificate:


Name:
Credentials:

Address:
City:
State:
Zip Code:

Business Phone:
Alternative Phone:

E-mail:

Special Needs?

Food Choice: Please select one	Pecan Chicken Fish Vegetarian

Breakout Sessions
Breakout Session 1	A B C
Breakout Session 2	A B C

Registration Fee:

$100.00 per MD/DO
$50.00 per PA/RN/NP

Please mail your check to:

Division of Gastroenterology & Hepatology
Attn: Kari Solar
9200 W. Wisconsin Avenue
Milwaukee, WI 53226

Any questions or concerns, please contact Kari Solar at 414-955-6850 or ksolar@mcw.edu