Your Full Name: ________________________________________________________________________________

Residency Program/ Organization: ______________________________________________________________

Address: _______________________________________________________________________________________

Email: __________________________________________________________________________________________

Phone: _________________________________________________________________________________________

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

NJ/NY March Board Review
  March 20, 21, & 22, 2020 (Fri, Sat & Sun)
  Courtyard Marriott Lyndhurst Meadowlands
  1 Polito Avenue, Lyndurst, NJ 07101

Washington DC Board Review
  April 17, 18, & 19, 2020 (Fri, Sat & Sun)
  Courtyard Marriott Washington DC / Foggy Bottom
  515 20th Street NW, Washington DC, 20006

Chicago Board Review
  May 22, 23, & 24, 2020 (Fri, Sat & Sun)
  Chicago Marriott O’Hare
  8535 West Higgins Road, Chicago, IL 60631

Connecticut Board Review
  June 12, 13, & 14, 2020 (Fri, Sat & Sun)
  University of Connecticut
  263 Farmington Avenue, Farmington, CT 06030

NJ/NY July Board Review
  July 24, 25, & 26, 2020 (Fri, Sat & Sun)
  Courtyard Marriott Secaucus Meadowlands
  455 Harmon Meadow Blvd., Secaucus, NJ 07094

Registration Fee and Special Discounts:

Physicians: $895
   Residents/Fellows in Training: $795
   Chief Residents/Resident Representatives: $595
   Note: Chief residents may qualify for additional discounts – Contact us

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 14 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 14 days of the course.
   A written notice is required by email for cancellation.