Registration Form

Link To Registration Form: /docs/Registration%20Form%20final(3).docx

Link To Online Registration Form: https://forms.gle/JZz7v9cPw2om8KQG7

Registration Form For: CardioSarasota, Florida 22/22/22

22nd Annual National Sarasota, Florida Congress for

Cardiovascular Disease Prevention and Optimal Treatment Update

Hosted by 22 of the Most Renowned National and International Professors in February 2022

 

 

 

Physicians……………………………………………..$250 Prior to Dec 31, 2021, Thereafter $400

 

Other Healthcare Professionals…………………………………………………………......…..$150

 

ISCVDP Members and Previous Attendees limited to 100 Prior to Dec 31, 2021…………......$100

 

Medical Students and Nurses (first 50 registrants), prior to Dec 31, 2021.…………….…….....Free

 

Public is invited free for Saturday Afternoon session.  Space is limited, must pre-register

 

 

Optional Lunch for Health Care Providers by invitation: Friday February 4, 2022

YES, I will attend

NO, I will not attend

Optional Dinner for Health Care Providers by invitation: Friday February 4, 2022

YES, I will attend

NO, I will not attend

Optional Breakfast Program by invitation: Saturday February 5, 2022

YES, I will attend

NO, I will not attend

Optional Lunch for Health Care Providers: Saturday February 5, 2022

YES, I will attend

NO, I will not attend

   Optional Dinner for Health Care Providers by invitation: Saturday    February 5, 2022

YES, I will attend

NO, I will not attend

 

 

Make checks payable to: International Society for Cardiovascular Disease Prevention

Prevention and mail to the address below. *

FOR CREDIT CARD PAYMENT CALL (941) 366-9805

Name: ___________________________________________________

Title: _____________________________________________________

Address: __________________________________________________

City: _____________________________State: _____Zip: __________

Facility: ___________________________________________________

Phone: ___________________________________________________

E-mail: ___________________________________________________

Name on Card______________________________________________

Card No. ____________________________________Exp____/_______

 

Send Registration Form & Appropriate Fee to:

International Society for Cardiovascular Disease Prevention

P.O. Box 433, Sarasota, FL 34230

Attn: M. El Shahawy, MD, Program Director