Registration Form

5th Annual
Houston Conference on Health Informatics
Beyond Wired: Wireless Technology and Health Information
Thursday, June 7, 2001, 8:30AM to 3:30PM
Kleberg Auditorium, Baylor College of Medicine
Texas Medical Center
Houston, Texas

You may register for the conference any of the following ways:

	Submit this form online by clicking the Submit Registration button at the bottom of this page.
	Print this form and FAX it to 713-799-7133.
	Print this form and hand carry it to the HAM-TMC Library.
	Print this form and mail it to:      Conference 2001      HAM-TMC Library      1133 M. D. Anderson Blvd.      Houston, Texas 77030-2809

Name:

Address:

Institution:

Phone/Pager:

Email Address:

Registration Fee (Includes Box Lunch & Break Refreshments)
$10 (Advanced registration)
$15 (Register on day of conference)
Student (Free with valid Texas Medical Center Student I.D.)

Reserve a box lunch for me:
I prefer a vegetarian lunch.
I prefer a non-vegetarian lunch..
Do not reserve a box lunch for me.
(Lunches guaranteed only if you register and pay by June 1)
 

I prefer to pay by:
Visa, Master Card, Discover, or American Express (Either follow the instructions that appear after you complete this form to submit your credit card information via secure online form or present your credit card when you pick up your badge on the day of the conference.)

Mailing my check (payable to HAM-TMC Library) to:
        Conference 2001
        HAM-TMC Library
        1133 M. D. Anderson Blvd.
        Houston, Texas 77030-2809