Surgical Management of Foot Deformities - December 19, 2009 COST: MUST BE PRE-REGISTERED FOR 2 SESSIONS SINCE SPACE IS LIMITED I have enclosed a check in the amount of $_____ as payment. Name: _____________________ Street Address: ________________________________ City: __________________ State: _____ Zip: ___________ Email: ___________________________ Telephone: ______________________ State License #: __________________ Make checks payable to: Temple University All major credit cards accepted. Type of Card: _______________ Expiration Date: _________ Card #: ________________ Signature:___________________ If paying by check, please mail completed Registration Form to: If paying by credit card, please fax Registration Form to:
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