Updates in Breast Health For Community Providers
Registration Form

Live Activity: UNM Domenici Center for Health Sciences, 1001 Stanford Dr. NE, Albuquerque, NM

April 27, 2024

Please plan on completing the form in its entirety. This site cannot save your information for completion at a later date.

Prior to starting this form: Complete your UNM Tuition Remission paperwork (remember proper signatures are REQUIRED), complete your UNM PR and make a copy of your check, you will be required to upload a copy of these documents at the end of this form. If you are a Medical Student proof of status IS REQUIRED. You will be required to upload a copy of your current class schedule showing you are a full time student. *Students will not receive professional credit.

CANCELATION NOTICE: If you cannot attend, UNM CPL will refund tuition, less a $40.00 administrative fee provided it is received in writing on or before April 12, 2024. No refunds will be issued after this date or for non-attendance. Conferences are subject to cancellation. In the event this conference is cancelled, UNM CPL is not responsible for any computer/device equipment rental or other costs incurred by participants.

Contact Information

First Name

Last Name

What is your preferred name to emphasize on your badge?

First Name, Nickname, etc... (e.g. Gary, Dr. Smith)

Credentials (i.e. MD, RN, PA, etc.)

Provide all of your credentials. If medical student, list Medical Student.

Specialty

Company/Institution

Professional Job Title

Street Address

City

State

Zip Code

What type of address is this?

Business

Home

Phone Number

Please select the type of number you provided above:

Email Address

Other Information

How did you hear about the activity

What type of CME credit do you need?

Do you plan to attend activity meals?

The deadline to place a meal order has passed (4/23/24). Please note that after this date, we will not guarantee meal availability.

Registration Fees

Registration Code - On Site

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Payment Method

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Updates in Breast Health For Community Providers Registration Form

Contact Information

Other Information

Registration Fees

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Updates in Breast Health For Community Providers
Registration Form