Click here if you will NOT be able to attend the conference,
but would like to purchase a program for $15.00.

Attendee Information


Full Name (to appear on badge)


First Name/Nickname (to appear on badge)


Medical Degrees


Medical Discipline


Address


City


State/Province


Zip/Postal Code


Country


Email Address


Phone Number


Fax Number


Preferred Roommate's Full Name

Roommate is:

Are you attending an ICPF conference
for the first time?
Yes   No
Registration Status and Fees
Select One Registration Fees
Physician/Other Professional $750.00
Resident $550.00


Registration includes: Meals, Facility Amenities and 3 Special Events (see Special Events page for more details).

Optional Special Events
     
Monday, September 22
Morning:
Pre-Meeting Live
Surgery Symposium
$100.00

   
Evening:
Sixth Floor Museum Cocktail Reception
Price To Be Determined
Please check if interested.

Wednesday, September 24
Evening:
Western Night in “Cowtown”
Price To Be Determined
Please check if interested.
 

Guest/Spouse Social Day Event Package
Will a guest or spouse be attending with you?
Yes   No


Guest/Spouse Full Name

Price $300.00
Package includes: Housing, Meals, Facility Amenities and all events listed below.
(see Special Events page for more details).

Monday, September 22
Fort Worth Stockyards & Sundance Square

Tuesday, September 23
City of Dallas Tour

Wednesday, September 24
Tour the Museum Capital of the Southwest

Thursday, September 25
Day of Nature & Shopping

Friday, September 26
State Fair of Texas