MiSHE Technical Seminar

Registration Form

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 sponsored by a MiSHE Member.

MiSHE
1620 70th Ave.
Evart, MI  49631

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 

MiSHE Sponsor's Name 

Click here when the form is complete.