2010 Meeting Registration Form

MEETING REGISTRATION FORM

EASTERN ALLERGY CONFERENCE (EAC)

May 6-9, 2010

The Breakers

Print this page and mail or fax to the address below:

Registration fee: $275.00  

The registration fee is waived for fellows in training.  After April 15, 2010 add an additional $25 to registration fee. 

Make check payable to Eastern Allergy Conference and mail to:

Eastern Allergy Conference

Providence, RI  02906

95 Pitman Street

Name ________________________________________________________ Degree ________________

Address ______________________________________________________________________________

City ________________________________________ State ______________ ZIP _________________

E-mail _______________________________________________________________________________

Telephone ___________________________________  Fax # __________________________________

Name of Spouse or Guests (for name badge) _______________________________________________

SYMPOSIUMS: There is no additional fee:

To register for the scheduled Symposium check here _____

(for CME credit, no fee required)

Method of Payment

Credit Card Information:  Circle one:  Master Card      VISA    AMEX

Card Number _____________________________________  Expiration Date _____________

Signature _________________________________________ Today's Date _______________

Contact Us

Questions for the Conference Director or Conference Coordinator? 

Contact Dr. Settipane or Ginny Loiselle at: (401) 223-1309

or www.Ginnyloiselle@easternallergyconference.org

Travel Planning?  Contact Creative Meeting Planners at 800-431-3004 or

401-723-6770 for discounted room, airfares, car rentals or

airport transfers.  Ask for Christy, Jamie, or Betty Lou.

 FAX THIS FORM TO 401-331-0223