* Required Fields
Prefix:
First Name*
Middle
Last Name*
Suffix
Title:
Organization:
Email Address*
Confirm Email Address*
Phone
Street Address 1
Street Address 2
City
State/Province
Postal Code
Country
Password*
Forgotten Password
Please enter the email address you provided during registration.
First Name Prefix First Middle Last, Suffix Title Organization
Attendee Type* General Public Partners Employee/Affiliate Hospital
Registration Fee: $650.00
This Early Bird special rate of $650 will be available until July 1, 2008 after which the price will increase to $795
Invitation Code:
Credit Card
Name On Card*
Credit Card Type* MasterCard Visa American Express Discover
Credit Card Number*
Credit Card Expiration* 01 02 03 04 05 06 07 08 09 10 11 12 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Partners Account
Please enter your 10 digit PeopleSoft Number (Example: 0100PH1234)
PeopleSoft Number*
Business Check
Please make your check out to Center for Connected Health and indicate on the check that it is for the Symposium Registration. Mail checks to the attention of: Matthew Jensen c/o Center for Connected Health 25 New Chardon St., Suite 400D Boston, MA 02114 Cancellation Policy: If an individual registration cancellation is received in writing on or before October 10, 2008 we will be happy to make a refund minus a $100 administrative charge. A registration substitution may be made with another member of your organization up to 5 days prior to the event. Please send notice of either request to mmspinale@partners.org.