Heal the Healer Symposium Inspiring Purpose, Passion and 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the designated fields: Name, Degree, Discipline, Address, City, State, ZIP, Phone, and Email. Ensure all details are accurate for effective communication.
3. Select your professional designation by checking the appropriate box (MD/DO, LSW, Psychologist, RN, Counselor, or Other). This helps us understand your background.
4. Review the registration fees based on your designation and note the deadlines for early registration to save costs.
5. Choose a method of payment. If University Hospitals is covering your fee, leave that section blank. Otherwise, fill in your payment details including card type and number.
6. Complete any additional required fields such as the amount paid and authorized signature before submitting.
7. Submit your completed form via email or fax as indicated in the instructions provided on the form.

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