Hyatt Regency Washington, DC on Capitol Hill Hotel
400 New Jersey Avenue NW
Washington, D.C. 20001
March 21-23, 2003
Please print and mail to: NHMA, 1411 K St., NW, Suite
200, Washington, DC 20005
or fax to: (202)628-5898
Please include a check, payable to National Hispanic Medical Association for registration
Name___________________________________________________________________
Degree(s)________________________Title____________________________________
Department______________________Organization______________________________
Street Address____________________________________________________________
____________________________________________________________
City____________________________State____________________Zip_____________
Telephone ( )________________Fax ( )_________________Email_______________
To pay by Credit Card:
Credit Card: ___VISA ___Mastercard
Name on Card:________________________________________
Account Number:______________________________________
Exp Date:________________
Signature:____________________________________________
REGISTRATION FEES
Conference Fee (Includes Friday Reception, Saturday Breakfast, Lunch, Awards Banquet and Sunday Breakfast, Lunch)
Early Registration: (Postmarked by March 1, 2003)
Members $300 Non-Members $350 Medical Residents/Students $100 Dinner Only $50
Late Registration:
Members $325 Non-Members $375 Medical Residents/Students $125 Dinner Only $50