Application for Membership Renewal

Symposium Registration with Online Payment

Use this form only if you are paying online at this time.

Symposium registration fee is $350 before Jan 15, and $400 after Jan 15

Contact Info:

First Name:

Last Name:

Street Address Line 1:

Street Address Line 2:

City:

State:

Zip Code:

Telephone Number:

Fax Number:

Email Address:

Registration Type:

Physician		CSFPS Member
Nurses, Assistants and Residents

Your Specialty:

Education on the Slopes with the Faculty

Please select one:

Beginner		Intermediate		Advanced
I Wish to Ski on my own.

Comments:

Next Step - Payment Processing

Questions? Please email Isabelle@csfps.org