34th Annual Agnes Seminar

March 15, 2025

Registration Form

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Seminar Information

Registration

Physician Registration (includes breakfast and lunch) - $240.00

Residents (includes breakfast and lunch) - $25.00

BUSPM Students - Free

BUSPM Full Time Faculty & Residents - Free

Podiatry License Information

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Special Needs

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Personal Information

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First Name

Middle Name

Last Name

Address Information

Address

Apt/Unit/Suite

City

State

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Phone

Fax

Cancellation/Refund Policy

Refunds less a $75 processing fee will be given when written notification is received postmarked by February 28, 2025. No refunds will be given for no-shows. BUSPM reserves the right to cancel the seminar up to two weeks prior to the start date of the seminar. BUSPM will make every effort to inform the participants as soon as possible in the event of cancellation. At no time will BUSPM be responsible for any other cost that may have been incurred by the registrant.

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Cancellation/Refund Policy

Refunds less a $75 processing fee will be given when written notification is received postmarked by February 15, 2025. No refunds will be given for no-shows. BUSPM reserves the right to cancel the seminar up to two weeks prior to the start date of the seminar. BUSPM will make every effort to inform the participants as soon as possible in the event of cancellation. At no time will BUSPM be responsible for any other cost that may have been incurred by the registrant.

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34th Annual Agnes Seminar

Registration Form

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