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: $845
 -Chief Residents: &695 
   -Group of 5 or more Residents joining from a Program: $795 per Resident
    Instructions for Group Registration: Residents can attend any of our Live Courses; they don’t have to attend the same course. One of the residents can provide names of the residents in the group via email and each of them can register separately.
–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.