HANDS ON

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Registration


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
  • E-mail: fmri.ah@gmail.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)


For Payment Options, please head over here.


For further information please contact:

Andrei Holodny, MD

holodny@fmri-course.com