MiSHE MEMBER SEMINAR SERIES

 

Directions: Please fill-in the registration form below. Fields that are marked  * must be filled. Use this form for each person attending. When complete, be sure to click on the submit button on this page. All participants must be  MiSHE Members.

MiSHE
1620 70th Ave.
Evart, MI  49631
231-734-3483

Click here when the form is complete.

*First Name  Middle Initial  *Last Name 

Title *Healthcare Institution Name 

*Address   *City  *State   *Zip 

*E-mail Address 

 *Phone  *Fax 

Member Number if known:

*Seminar Series Date:    NOTE: Registration information will follow this page.

Click here when the form is complete.