Health Policy Forum Registration

Michigan Health Policy Forum

April 28, 2008
1 – 4:30 PM
Lincoln Room - Kellogg Hotel and Conference Center
East Lansing, Michigan

First Name

Last Name

Title

Additional Title, if any

Credential

(MD, PhD, etc.)

Organization

Address

City

State

Zip Code

Phone

Fax

E-mail Address

Alternate E-mail Address, if any

UserName

Password

Please check one option below:

Yes, I plan to attend the April 28, 2008, forum.

No, I cannot attend the April 28, 2008, forum but keep me informed of other upcoming events.

Call Mark Bitman at (517) 355-3393 or email him with any questions. Please let us know if you have special needs so we may address them before the conference date.