February 28-29, 2020
Disney's Grand Californian Hotel & Spa – Disneyland Resort
1600 Disneyland Dr, Anaheim, CA 92802
Fields marked with an asterisk(*) are required.
Registration Type*
Registration fees*:   

Personal Information
First Name*:
Last Name*:
Phone Number*:
Email*:
Degree/Credentials*:
Medical Specialty*:
Mailing Address
Address 1*:
Address 2:
City:*
State:
Zip:
Country (if outside of U.S.):
 
Special Instructions: For example if you need assistance or have dietary restrictions
 
Type of practice*:
Years in practice:
Days you will attend course*:

Do you plan to attend the hands-on section of the course?*
Billing Information (on credit card):
First Name*:
Last Name*:


Cancellation policy:
  • Please send cancellation requests to Rachel Biby at bd-ucihealth@uci.edu or 714-456-3943.
  • A handling fee of $75 is deducted for cancellations.
  • Refund requests must be received by email by Dec. 31, 2019. No refunds will be made thereafter.