airporthotelcostdetails

 

First Name (required)

Last Name (required)

Title/Degree/Specialty

Street Address (required)

City (required)

State (required)

Zip (required)

Cell Phone (required)

Home Phone

Your Email (required)

Please reserve my place to attend the Medical Leadership Conference February 17 & 18, 2017.

Please indicate your payment choice (required):
 My non-refundable payment was sent through paypal I plan to mail my non-refundable payment

Please acknowledge that you will provide your own transportation (required):
 I understand I must provide my own roundtrip transportation to Miami and will provide my flight information or driving arrival time to Lourdes Volunteers.

 I plan to drive to Miami/Kendall, FL I plan to fly to Miami-MIA airport

 I have made my reservation with the Holiday Inn Express

Arrival Day/Time:

Check-Out Day/Time:

 I would like to join the Sunday excursion to the Florida Keys.

Describe any special needs with which we could assist during the conference:

Is there anything else you want us to know?

To pay your registration fee of $199 via PayPal:




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