Medical & Dental Professionals – Volunteering to Serve Others!

Expanding the Mission:

Free Clinics of Great Lakes Region - 8^th Annual Conference

April 22-23, 2004 in Rochester, Minnesota

The Kahler Hotel is the official conference hotel and is adjacent to Mayo Clinic Rochester

This Conference Hosted by: Free Medical Clinic

Yes, I will be attending:

Registration: $150.00 after January 15, 2004

or $135.00 postmarked by 1/15/04

Yes, I want to save 10% by registering & paying early (January 15, 2004)

Attached is my payment. Please pre-register me!

Name: _______________________________________________

Clinic: _______________________________________________

Address: ________________________________________________

City: _________________________________ ST: ____________ Zip Code: ________

Phone: _________________________ Email: __________________________

My responsibility at the clinic:

____ Administration _____ Physician _____ Nursing Staff

____Development / Volunteer Director _____ Pharmacy

_____ Other __________________________________________________

Thank You!

Print registration form, complete and send with check payable to The Salvation Army to:

The Salvation Army Free Medical Clinic

PO Box 575

Rochester, MN 55903