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The 41st Annual Southeastern Consortium for Dermatology
November 3 - 5, 2017
Augusta Convention Center, Augusta, GA

Contact Info, Bio, Itinerary

Contact Info, Bio, Itinerary | Educational Objectives | AV, Final Presentation, Handouts | Disclosure

Speaker Name: *
Email Address: *
Required entries with every submission*


Contact Information

Please list how you wish to be listed in the program


Mailing address:
Office Phone:
Mobile Phone:
Home Phone:
Fax:
Assistant's Name:
Assistant's Phone:
Assistant's Email
Address:



BIO (used in the Syllabus and excerpts taken for verbal introduction)



CME
I am seeking CME credit for this meeting
I am NOT seeking CME credit for this meeting.


TRAVEL
I am driving to and from the meeting location (skip ahead to ACCOMODATIONS)
I am FLYING to and from the meeting location (please complete Arrival/Departure info below)

ARRIVAL
I DO / I DO NOT wish to be shuttled from the airport to the hotel and will arrange my own ground transportation
Airport:      Airline:
Arrival date:      Flight Number      Arrival Time:

DEPARTURE
I DO / I DO NOT wish to be shuttled from the airport to the hotel and will arrange my own ground transportation
Airport:     Airline:
Departure date:      Flight Number:      Departure Time:



ACCOMMODATIONS
I have been told the SEC will make my room reservation.
OR
I understand I will be making my own room reservation. Click here for accommodation details and options.

Please complete the following in either case:
I will be checking in on
I will be checking out on








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