Registration Form

There are 12 two-hour sessions and three one-hour Plenary Sessions. The Pediatrician of Tomorrow Luncheon presentation is approved for CME credit. You must pick only one of the sessions that are provided in the morning and only one in the afternoon. The Plenary Sessions are for all registrants, and included in your registration. Please indicate the Plenary Sessions that you are attending and use the numbers of the seminars in making your choice. (Please do not use this form for more than one person.)

Name	Street Address	City	State

ZIP Code	Phone	Fax	E-mail

Please check Profession:
PediatricsDOCFNPIU Resident Medicine/pediatricsPhDRNNon-IU Resident Family practitioner MDCPNPPhysician/medical assistant