Your Full Name: ________________________________________________________________________________

Residency Program/ Organization: ______________________________________________________________

Address: _______________________________________________________________________________________

Email: __________________________________________________________________________________________

Phone: _________________________________________________________________________________________

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

March Board Review Course
  March 12, 13, & 14, 2021 (Fri, Sat & Sun)
  Virtual Classroom – via Live Stream

May Board Review Course
  May 21, 22, & 23, 2021 (Fri, Sat & Sun)
  Virtual Classroom – via Live Stream

June Board Review Course
  June 11, 12, & 13, 2021 (Fri, Sat & Sun)
  Virtual Classroom – via Live Stream

July Board Review Course
  July 9, 10, & 11, 2021 (Fri, Sat & Sun)
  Virtual Classroom – via Live Stream

September Board Review Course
  September  10, 11, & 12, 2021 (Fri, Sat & Sun)
Virtual Classroom via Live Stream

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