1. Default Section

1. First and Last Name

2. Discipline

3. Are you a student?

4. Organization or School you are with

5. Your Address

6. City

7. Zipcode

8. Phone

9. email address

10. For continuing education purposes, what is your birth MONTH and DAY (year not needed).

11. What type of Continuing Education are you requesting?

12. What is your method of payment?
Note: $50 registration fee (or a PO) is due on our office by October 16th. Registration Fee for those registering after October 16th or at the door is $75. Registration fee includes parking, lunch and continuing education.

13. Please send payment to
5323 Harry Hines BLVD
Dallas, Texas 75390-8818

For information contact chong.lee@utsouthwestern.edu