* 1. Contact Information

* 2. Please enter the names of each person attending (if more than 10 are attending, please contact Kristy Brown at 734-232-3814 or kribro@med.umich.edu):

* 4. Select method of payment.  
Note: Registration is NOT confirmed until payment is received. Please make payment in-person or send to Kristy Brown at:

University of Michigan Trauma Burn Center
Attention: Kristy Brown
1500 E. Medical Center Drive, Room UH-1C435
Ann Arbor, MI 48109-5033
Any questions, please call 734-232-3814 or email kribro@med.umich.edu

* 5. Please Note:  The Trauma Burn Center financially subsidizes this event to offer reduced-cost registration.  Are you interested in donating a gift to help us continue providing this community event?