Hot Topics in Trauma 2018 Registration - April 6, 2018

In order for this form to be properly processed please print out the form, fill out the section
below and mail it in its entirety (along with payment) to:       

NIEC - Hot Topics 2018
PO Box 11176
Philadelphia, PA 19136

Tuition (check one or more):  ____ Physicians $195.00  ___ All others $145.00

Make checks payable to: "NIEC"

Name:___________________________________________________________________

Address:_________________________________________________________________

City:________________________________________ State:_____ Zip:______________

Phone (Day):____________________________ (Evening):________________________

Check one:  ___ MD/DO ___ EMT-P ___ EMT ___ PHRN ___ Other:___________

For room reservations call Bally's at 1-800-345-7253.  Mention the NIEC conference to receive a
preferred room rate. For all other questions please call 215-624-4500.

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