Oral Review Registration
Cardiovascular & Thoracic Surgery Core Curriculum Review - 2008

Name: _______________________________________________________________________

Address: _____________________________________________________________________

City: ____________________________________________ State:_______ Zip: _____________

Phone: ________________________ E-mail address: __________________________________

Discover _______   American Express ________   Visa/Mastercard ________

Card# __________________________________________________ Exp. Date ____________

Signature _____________________________________________________________________

Please make checks payable to Intermountain Healthcare CME, and mail to:

Continuing Medical Education
36 South State Street, Suite 1600
Salt Lake City, UT 84111

or

Fax this completed form with credit card information to (801) 442-3929.

IMPORTANT - You must call the CME office at 1-800-842-5498 to receive your session time.