PVICME: Registration

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Pacific Vascular Institute for Continuing Medical Education (PVICME)
11714 North Creek Pkwy N
Suite 100
Bothell, WA. 98011
Phone: (425) 398-7772
Fax: (425) 486-8976

or email PVICME Director at

2010 Registration Form

(Registrants are required to complete all fields below marked with *)

*First Name:

*Last Name:

*Credentials:

*Email Address:

Billing Information

*Bill to (name):

  Department:

*Address:

*City:

*State:

*Zip Code:

*Phone:

  Fax:

Please select a course(s) below that matches your requirements.

ABDOMINAL VASCULAR COURSE

October 15 - 16, 2010
[Course Fee: $675.00]

TRANSCRANIAL DOPPLER (TCD) AND IMAGING (TCI)

September 15 - 17, 2010

[Course Fee: $875.00] -
Note: Course Location - Swedish/Cherry Hill Hospital Campus, Seattle, WA

PHYSICIAN'S INTERPRETATION WORKSHOP

October 29 - 30, 2010 (8:00 - 4:00pm)

Complete Series - [$800.00]

October 29, Day 1: (8:00 - 4:00pm) Cerebrovascular/Carotid: Interpretation & Case Study
October 30, Day 2: (8:00 - 4:00pm) LEA & LEV/Renal Interpretation & Case Study
[Course Fee: $550.00]

VASCULAR ULTRASOUND
"A foundation to build from"

   SEPTEMBER Complete 4-Day Series
   September 27 - 30, 2010
      Complete 4-Day Series - [$1025.00]

Carotid Duplex/Upper Extremty (Arterial & Venous), Days 1 & 2
September 27 - 28, 2010
[Course Fee - $600.00]

Renal Vascular / Lower Extremity Arterials, Day 3
September 29, 2010
[Course Fee - $300.00]

Lower Extremity Venous, Day 4
September 30, 2010
[Course Fee - $300.00]

NOVEMBER Complete 5 - Day Series
November 1 - 5, 2010
Complete 5 - Day Series - [$1300.00]

Carotid Duplex/Upper Extremty (Arterial & Venous), Days 1 & 2
November 1 - 2, 2010
[Course Fee - $600.00]

Renal Vascular / Lower Extremity Arterials, Day 3
November 3, 2010
[Course Fee - $300.00]

Lower Extremity Venous, Day 4
November 4, 2010
[Course Fee - $300.00]

Venous Insufficiency, Day 5
November 5 , 2010
[Course Fee - $300.00]

Please call (425) 398-7772 to make payment arrangements and/or if you have any questions with regard to the courses, thank you.

Deposit: A $250.00 deposit is required to secure enrollment. Please include credit card information or check with registration. Course Cancellation: Cancellation thirty (30) days prior to the course. Full refund less a $125 administrative fee. Cancellation (21))twenty one days or less prior to the course. Forfeiture of the $250.00 deposit. A minimum of 8 students is required to confirm a course. Please do not book nonrefundable airline tickets unless you have confirmed the minimum has been met. PVICME/ Pacific Vascular will not assume any liability for nonrefundable airline tickets. PVICME, a division within Pacific Vascular, reserves the right to cancel any course within 10 days of the course for any reason. PVICME 18702 North Creek Parkway, Suite 212, Bothell, WA 98011 Phone (425) 398-7772 / Fax (425) 486-8976 / Web site www.pvicme.com. Email dfields@pacificvascular.com.