Your Full Name: ________________________________________________________________________________

Residency Program/ Organization: ______________________________________________________________

Home Address: _________________________________________________________________________________

Personal Email: _________________________________________________________________________________

Cell Phone: _____________________________________________________________________________________

   Choose from one of our five Virtual Classroom Courses (Circle the course you wish to attend)

1.March Board Review Course
  March 9 & 10, 2024 (Sat & Sun)
  Virtual Classroom – via Live Stream

2.May Board Review Course
  May 18 & 19, 2024 (Sat & Sun)
  Virtual Classroom – via Live Stream

3.June Board Review Course
  June 8 & 9, 2024 (Sat & Sun)
  Virtual Classroom – via Live Stream

4.July Board Review Course
  June 13 & 14, 2024 (Sat & Sun)
  Virtual Classroom – via Live Stream

  5.September Board Review Course
  September 7 & 8, 2024 (Sat & Sun)
  Virtual Classroom – via Live Stream

Registration Fee and Special Discounts:

 -Physicians: $695
   -Residents/Fellows in Training: $595
 -Chief Residents: &495 
   
–Note:
    Chief residents and Residents in larger group may qualify for additional discounts; Contact us via
    Email: info@imedicinereview.com

Mail this Registration form with Check payable to “iMedicine Review” to the following address:
   iMedicine Review
   1268 Meadowbrook Rd.
   Lancaster, PA 17603

Cancellation Policy: 
   If you cancel at least 30 days prior to start of the course we will refund the balance of your tuition fee after
   deducting  a $100 processing fee. There is no refund for cancellations within 30 days of the course.
   A written notice is required by email for cancellation. 

 Comprehensive Board Review Course Book (Separate purchase) 
    –If you wish to purchase ‘iMedicine Comprehensive Board Review Self-Assessment Course Book‘, Click the Publisher’s Link: Purchase the iMedicine Board Review Course Book from Dorrance Publishing.