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Seminar Registration
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Seminar Details
Date and Time of Seminar:
May 23, 2012, 6:30 PM - 8:30 PM
June 4, 2012, 12:00 PM - 1:00 PM
July 2, 2012, 12:00 PM - 1:00 PM
July 11, 2012, 6:30 PM - 8:30 PM
August 6, 2012, 12:00 PM - 1:00 PM
September 3, 2012, 12:00 PM - 1:00 PM
September 26, 2012, 6:30 PM - 8:30 PM
October 1, 2012, 12:00 PM - 1:00 PM
November 5, 2012, 12:00 PM - 1:00 PM
November 7, 2012, 6:30 PM - 8:30 AM
December 3, 2012, 12:00 PM - 1:00 PM
December 19, 2012, 6:30 PM - 8:30 PM
Title:
Weight Loss Surgery Seminar
Where
Center for Advanced Laparoscopic and Bariatric Surgery - 502 West 2nd St. Bloomington, IN 47403
Patient Information
Date of Birth:
*
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Height
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Pounds
First Name:
*
Last Name:
*
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Contact Information
Address 1:
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City:
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Zip:
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Excluding yourself, how many guests will you bring?
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