Your Full Name: ________________________________________________________________________________

Residency Program/ Organization: ______________________________________________________________

Home Address: _________________________________________________________________________________

Personal Email: _________________________________________________________________________________

Phone: _________________________________________________________________________________________

   Choose from one of our five convenient locations (Circle the course you wish to attend)

March Board Review Course
  March 18, 19, & 20, 2022 (Fri, Sat & Sun)
  Virtual Classroom – via Live Stream

May Board Review Course
  May 20, 21, & 22, 2022 (Fri, Sat & Sun)
  Virtual Classroom – via Live Stream

June Board Review Course
  June 17, 18, & 19, 2022 (Fri, Sat & Sun)
  Virtual Classroom – via Live Stream

July Board Review Course
  July 15, 16, & 17, 2022 (Fri, Sat & Sun)
  Virtual Classroom – via Live Stream

September Board Review Course
  September 9, 10, & 11, 2022 (Fri, Sat & Sun)
  Virtual Classroom – via Live Stream

Registration Fee and Special Discounts:

 -Physicians: $895
   -Residents/Fellows in Training: $795
 -Chief Residents: &595 
   
–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.