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Registration Form

Please fill out the form below in order to register for Focus On Females. If you prefer, we have posted a PDF file here that you can download and fill out and mail in.

Click here to download the pdf document

PLEASE NOTE: To avoid duplicate registrations errors, we have made the First Name, Last Name & email address a unique field. You will only be allowed to register one person using a specific first name, last name, and email address. If you need to register additional individuals you will need to use their name with your email address or they will need to register under their email address. You can register same family members by just changing the name fields only. Thank you.
* First Name:
* Last Name:
Address:
Apt / Suite Number:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Cell Phone:
* Email Address:
  May we send you a post event e-mail questionnaire?
Yes No
  Do we have your authorization to provide your e-mail address to participating specialists & physicians?
Yes No
Lunch Option: Would you like to have a lunch reserved for you prepared by the Tampa Convention Center Catering Service? Lunch would include:
  • Mixed green salad with choice of dressing
  • Roasted tri color quinoa with vegetable
  • Roasted chicken quarters garlic au jus
  • Chef’s Choice Bread
  • Choice of Water Bottle or Canned Soda
  • Additional items to be available at the register for sale to include whole fruit and bags of baked lays chips.
Total Price with Tax per person: $ 9.00 (cash, debit, visa or mastercard) (Pay when you receive lunch)
Yes No

  PLEASE NOTE: Doors will open at 7:30am and we invite you to visit our sponsor and exhibitor booths before the seminars begin at 9:00am.
  Seminar Schedule Preferences - Please select the seminars you would like to attend (only 1 per time slot).
 
  * Seats are first come first serve
  Do you work part-time or full-time?
  Full Time Part Time Neither
 
Household Income:
 
Age:
 
Gender:
 
  * How did you hear about the Symposium?
 
No data
If Other, Please Specify:
 
Press the Submit button to complete registration process.