Ohio Association of Oral and Maxillofacial Surgeons

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OSOMS Meeting Registration Form     

      July 17th, 18th, 19th, 2009

 

OSOMS MEMBER    250.00

OSOMS RESIDENT         No charge

GUESTS                           325.00

 

OSOMS LUNCHEON    20.00

 

 

Name: ­­­­­­________________________

 

Address _______________________

 

______________________________

 

E-mail address__________________

 

 

MEMBERS  ___________________

                                   $250.00

Non-Members __________________                               

                                $325.00

Luncheon______________________

residents are charged for luncheon)

 

SATURDAY  SOCIAL 6:30 PM

Cocktail Party – The Riverview

Number attending_______________

 

***  Dinner on your own

 

REGISTRATION TOTAL

Scientific Session / Luncheon

Total Amount _________________

 

*** Checks payable to: OSOMS

        mail to:  OSOMS

                      2241 Greenlawn Drive

                       Toledo, OH   43614

(Credit cards are not accepted )

 

Additional late charge of $50.00

for reservations received after

June 17, 2009

 

Questions: dfarley976@aol.com

 

 

 Meeting details listed above in Events