2020 MCI Registration

MCI Symposium/Workshop/Forum Registration
Badge Information

Information which will be printed on your badge
Full Name *

First Name Last Name
Suffix (Choose all that apply) *

PhD MD PsyD DO LCSW MSW RN MBA MS MA BS BA
Organization *
City, State/Province *
Would you like to include your name and organization (only) on the list of participants (to be distributed at the event)? *

Yes No
Main affiliation/Industry *
Please detail "Other"
Contact Information

Please enter your contact information

Contact Address *

Phone Number (use "1" for US) *

Country Code Area Code Phone Number
E-mail *

Confirmation Email
Logistics

A few questions to help us prepare for your participation and serve you better
How did you hear about the event? *

Email from organizers Postcard Website Event Directory Word-of-Mouth Attended previous editions
Will you require CME or CE credits? *

CME CE No credits needed
If you have a physical, dietary or communication need that may affect your participation in conference activities, please note so here.
Although the organizers will attempt to accommodate each special request, no guarantees can be made.
Registration Categories

Please select the appropriate delegate category and event:
To encourage local participation, Mount Sinai Medical Center is generously offering all Florida residents 50% off early-bird fees - they may use coupon code FLORIDAORG20. Please note that a Florida residence will be required at the time of payment and conference check-in.

Registration Category and Event (Symposium/Workshop/Forum) selection:

PHYSICIAN REGISTRATION (MD, DO, MDCM, etc.) $ 450.00

Now select the event(s):

NON-PHYSICIAN REGISTRATION (PhD, LCSW, MSW, MS, etc.) $ 350.00

Now select the event(s):

STUDENT/POST-DOCTORAL FELLOW REGISTRATION* $ 175.00

Now select the event(s):

PUBLIC EDUCATIONAL FORUM Free

NETWORKING RECEPTION GUEST** (accompanied by paying delegate) $ 35.00

Enter coupon

Total $ 0.00

* Academic credentials will be requested at check-in.

** Registrant's reception guest access to the networking reception only, January 18, 2020. Guest must be accompanied by a paying delegate.
ADMIN COMMENTS
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Badge Information