Welcome to M.A.S. Socket Design

MAS Basic Hands-On Course

14.0 CEU’s awarded by ABC	Location:

July 26-27, 2008	Chicago, IL Northwestern University Prosthetic & Orthotic Center

Credit card information must be received for registration to be processed.
Your credit card will not be billed until 45 days prior to the seminar.

Contact Information:

OPGA
P.O. Box 1467
Waterloo, IA 50704
Attn: Jim Andreassen

Cancellations must be received in writing
45 days prior to seminar to be refundable.
All cancellations are subject to a $25 handling fee.

***Minimum class size required***
OPGA reserves the right to cancel seminar due to lack of participation

Fax: 888-449-0610
Phone: 800-214-6742

Registration is limited

1. Complete the following registration information:

OPGA number:

Name:

Company:

Address:

City:

State:

Zip:

Phone number:

Fax number:

Email Address:

yourname@yourcompany.com

Which seminar would you prefer to attend?

July 26-27, 2008

2. Type of tier desired:

Tier I – “Hands-On” – Full two-day seminar, which includes patient evaluation with casting, modifications, and two test sockets. Attendee must provide own patient model and his/her travel arrangements
Fee
$1,095 for OPGA members
$1,990 for non-OPGA/Point members

Tier II – “Observation” – Full two-day seminar, which includes observation of patient evaluation, but no hands-on participation
Fee
$695 for OPGA members
$1,090 for non-OPGA/Point members

Note: Class size is limited to 36 (12 Tier I and 24 Tier II) participants and will be offered on a first-come, first-serve basis.

All registration fees include the following:

Tuition fees for the full two-day seminar

Evaluation materials for Tier I participants (plaster, test sockets, fabrication services, etc.)

Class room materials

Breakfast, lunch and afternoon breaks Saturday-Sunday for attendees and patient models

Dinner on Saturday and Sunday nights for attendees and patient models

3. For hotel reservations, complete the following:

Method of travel:

Flying

Driving

Arrival date

Departure date

Room Preferences:

Smoking

Non-smoking

Single

Double

Roommate

We will contact you with your confirmation number and room rate

4. Select payment method and enter total.

Your credit card will not be billed until 45 days prior to the seminar

Bill my Credit Card

Visa #

(ex. 1234567890123456)

Exp. date:

(ex. 01/00)

Master Card #

(ex. 1234567890123456)

Exp. date:

(ex. 01/00)

AMEX #

(ex. 1234567890123456)

Exp. date:

(ex. 01/00)

Name exactly as it appears on Credit Card

Authorization Code

Total Fee Charged

Pay By Check		Mail checks to: OPGA P.O. Box 1467 Waterloo, IA 50704 Attn: Jim Andreassen
	I understand that the check must be received to ensure a spot for the seminar.