DISCIPLE-MAKING SEMINAR REGISTRATION
April 16-18, 1999
Name:___________________________________________________________________________
First
 Middle Initial Last

Degree:___________ Specialty:_____________________________________________________


Spouse (if attending):_____________________________________________________________


Home Addresses:_________________________________________________________________
Street

_________________________________________________________________________________
        City State Zip


Office Address:___________________________________________________________________
Street

_________________________________________________________________________________
        City State Zip


E-mail:___________________________________________________________oHome oOffice

o Prefer vegetarian meals

Seminar Fee Calculation:

o Professional
o Nurse/Allied Health Professional/Chaplain
o Resident
o Student:   oMedical oDental oNursing oOther

Seminar Fee includes:
Registration and five meals

Registration Deadline is April 9, 1999
Payment in full must be received by this date.
Fee is non-refundable after registration deadline.
Late registrants should call (909) 795-8738 to check on space availability.


Make checks payable to:
The Medical Strategic Network
P.O. Box 2052
Redlands, CA 92373