* indicates required fields
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* First Name:
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* Last Name:
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* Primary Degree:
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* Degree(s) as it should appear on your certificate:
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*Are you a Resident or Student?
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* Specialty:
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Secondary Specialty:
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* Address:
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* City:
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* State:
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* Zip Code:
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* Country:
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* Phone Number:
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Fax:
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Emergency Contact Name:
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Emergency Contact Phone Number:
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* Email Address:
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Special Instructions:
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| Are you a graduate of Boston University School of Medicine?
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| If so, in what year did you graduate?
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Are you a Boston University School of Medicine or Boston Medical Center faculty or staff member?
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| If yes, please provide your ID number for verification
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*Do you want to be included on the BUSM CME e-mail list?
Yes
No
* Do you want to be included on the conference participant list?
Yes
No |
| TUITION |
| MD / DO |
$199 |
| Allied Health Professional |
$125 |
| Resident/Student |
$75 |
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Substitution/Cancellation Policy
Substitutions may be made at any time without an additional charge. Refunds will be issued for all cancellations received three weeks prior to the start of the conference. Should cancellation occur within the three-week window, a credit will be issued, not a refund. A $50.00 administrative fee will be charged for all refunds and credits. “No shows” are subject to the full course fee. Cancellation/substitution(s) must be made in writing. Refunds or credits will not be issued once the conference has started. This course is subject to change or cancellation.
Special Services/Dietary Needs
To request reasonable accommodations for disabilities, please notify the CME office, in writing, at least two weeks prior to the start of the conference. The CME office will work to accommodate dietary requests (including, but not limited to: kosher, vegetarian, low- cholesterol, and low-sodium meals) received, in writing, at least two weeks prior to the start of the conference. |
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Boston University School of Medicine Continuing Medical Education
72 East Concord Street, A402, Boston, MA 02118
Phone: (617) 638-4605 // Toll-Free: (800) 688-2475 // Email: cme@bu.edu // Website: www.bu.edu/cme
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