BAKER GORDON EDUCATIONAL SYMPOSIUM
February 11th – 13th, 2010, Miami, Florida

Please complete and return this form, accompanied by your check, made payable
to Baker Gordon Educational Symposium, in U.S. Funds only, DRAWN ON A U.S.
BANK, or your credit card authorization. You may mail or fax registration.

To:
EDUCATIONAL SYMPOSIUM
Attn: Mary Felpeto
3225 Aviation Avenue
Suite #100
Coconut Grove, FL 33133
Please review "Cancellation Policy"

Symposium phone: (305) 859-8250
Fax number: (305) 854-3423
PLEASE! Do NOT call Mercy Hospital

* Required Information

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Please print out this form, fill it in and either mail or fax back to address or fax number above.