NEW YORK STATE OSTEOPATHIC MEDICAL SOCIETY
DO DAY IN ALBANY
Tuesday, April 17, 2012

REGISTRATION FORM

NYSOMS is arranging round trip transportation if the response supports it.

      *-required
*First Name: *Last Name:
           
AOA Member Number:    
       
*Address:
           
*City: *State: *Zip:
           
  *County:      
           
*Telephone: Fax:    
           
*****NYSOMS will provide updates via email*****
           
  *Email:    
           
 
I am traveling from the New York City Metropolitan Area interested in transportation from
 Manhattan
          Long Island
    NYSOMS is arranging round trip transportation from the NYC Metropolitan area.  
           
 
I am traveling from another area of the state with a larger group and interested in working with NYSOMS to arrange transportation from
           
 
I am interested but need help with transportation from
   
           
           
         

 

New York State Osteopathic Medical Society
1855 Broadway, New York, NY 10023
Toll Free: 800-841-4131 | Direct Line: 212-261-1784 | Fax: 212-261-1786
E-mail: info@nysoms.org
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