Registration Form

Completing this registration form will register you for the 2008 Pain Conference. Early-bird pricing (USD$115) ends August 27th, 2008. Regular price is USD$130.

First Name:	Last Name:
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Address 2:
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Home Phone (xxx-xxx-xxxx):	Work Phone (xxx-xxx-xxxx):
E-mail Address:	Fax (xxx-xxx-xxxx):

Please Choose a Morning Session and an Afternoon Session to Attend:

AM Sessions   A. Using Methadone to Treat Pain
B. I Want to Shake Your Hand... Providing Compassionate Care When Touch Is Painful
C. Pain Associated with Trauma and PTSD

PM Sessions   D. The Pain of It All: Management of Neuropathic Pain
E. When Anxiety, Depression and Pain Intersect
F. The Effects of Activity & Ambulation on Pain

Check here to remove your above information from the published participants list.

I am a student and would like the discounted student price (USD$70).

Payer's Name - If someone other than yourself will be paying for this registration, please indicate the person's name below.


Comments/Special Requests - If you have any comments and/or special requests (vegetarian meal, special accomodations) please list them here.