Texas Health Resources
SPORTS MEDICINE SYMPOSIUM 2019
Registration Form
March 29-31
Hilton Southlake Town Square
EARLY REGISTRATION DEADLINE – MARCH 18, 2019
Please complete this on-line registration form whether paying via check or credit card so that we will capture all of your info for proper documentation. Confirmation is sent via email to all registrants - please provide a valid email address when registering.
Hilton Dallas Reservation Information
For a printable copy click here.
Please complete the form below. A RED asterisk (*) denotes required fields.
After completing all fields click on the Submit button.

REGISTRANT INFORMATION *

Name:*
    First Name:*
    Last Name:*
    MI:


Address:*

City:*
State:* Zip:*
Phone:*

Email Adddress *
Workplace:*
Credentials:*
Special Requests:


LAB SELECTIONS - Select 3 Saturday Labs *
SATURDAY








TUITION FEES - Select Fee Level *




Payment Information

*** Amount *  



Card Type:


Please enter information below exactly as it appears on the credit card.

Cardholder Name: *
Card Number: *
Expiration Date: * Year
Billing Address Billing address same as above.
Credit Card Billing Address: *
Credit Card Billing City: *
Credit Card Billing State: *
Credit Card Billing Zip Code: *

Please enter authentication challenge characters below and click Submit button only once.

 
Booking Link:

Hotel: Hilton Dallas/Southlake Town Square

Hotel Tel. No.: 817 – 442 9900

Group Name: 16th Annual DFW Sports Medicine Symposium 2019

Arrival Date: 29-Mar-2019

Departure Date: 31-Mar-2019

Texas Health Sports Medicine
800 5th Ave, Ste 150
FW, TX 76104
817.250.7517
817.250.7538 fax
www.texashealth.org
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