Ellis Hospital 2005regform Page 1
Rehabilitation Services
1101 Nott Street Schenectady, NY 12308
Phone: (518)243-1904 www.ellishospital.org
Registration Form
* Check Course you are registering for:
Diagnosis of Mechanical Dysfunction and Stability, Retraining
of the Shoulder Girdle
Sept 29-Oct 1, 2006
Cost: $450.00
Name:
Address:
Phone:
E-mail:
Fax:
Payment Enclosed:
Am Ex MC Visa Personal Check Company Check
Card
#:
Exp.
Date:
Check Number:
Make checks payable to: "Ellis Hospital Foundation" c/o Pagnato Fund
To Register:
1. Phone: 518-243-1904
2. Fax: 518-243-1399
3. Mail: Ellis Hospital Rehabilitation Services, 1101 Nott St., Schenectady, NY
12308
If you have any questions please call Bob Fleming at 518-243-1904 or 518-857-7528.
You can review our cancellation policy and see the entire 2006 Continuing Education
Series at
www.ellishospital.org
and click on "Rehabilitation Services".
* To register for any of our other courses for our 2006 Continuing Education Series,
contact the appropriate organization listed.
