HANDS ON

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Registration by Check


Registration Fee is $2000. Registration is limited to enhance the individualized attention from the faculty and hands-on experience, so please register as soon as possible.


Please complete the following information below and return by fax (917 - 432 - 2345) or e-mail holodny@fmri-course.com.


Last Name, First Name MI, Highest Degree:

Department (include box no).:

Institution:

Street:

City State/Foreign Country Zip or Mail Code:

E-mail Address:

Daytime Phone (with area code):

Fax (with area code):

Where did you hear about us:


Please make check payable to:

fMRI Consultants LLC

63 Prospect Street

Demarest, NJ 07627-1023

For further information please contact:

Andrei Holodny, MD

holodny@fmri-course.com

If you would prefer to register by PayPal, please click here.

Full refunds, less $200 administrative fee, will be granted to those providing written notification of withdrawal with at least 30 days notice. After that date, no refunds will be given.


If you have additional questions, don't hesitate to call (201) 767-1942.