To register for the Second Annual Bioethics, Spirituality and Humanism in Medicine Conference, please complete the information below. In order to receive a discounted early registration fee, you must be registered by May 17, 2013.

If you have any questions regarding CME registration, please contact Brenda Chezek at bchezek@kcumb.edu

* Required
 
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First Name:
 
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Last Name:
Degree/Credentials (D.O., M.D., etc):
 
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Area of Practice Specialty:
 
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Years in Practice:
Location of current practice:
(check all that apply)
 
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Type of employer:
Brand of medical records system:
 
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Mailing Address:
 
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City:
 
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State:
   
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Zip Code:
   
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Phone:
   
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Email:
Alternate Email (admin assistant, home, etc.):
 
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Are you an alum of KCUMB?
Non-attendee additional lunch tickets ($30/ticket):  
List any special dietary needs (leave blank for none):
The KCUMB Continuing Medical Education staff can assist you with special accommodations for this event.  Would you like to be contacted by member of the CME staff?
   

To determine your registration fee, please check the one that best describes you:










  
Course registration fee includes daily continental breakfast and lunch, refreshments, course material and CME Certificate of Attendance.