pink ribbon

REGISTRATION FORM
Online Registration Deadline: Thursday, October 11, 2018
Participant Information
* First Name: * Last Name:
* Email: * Phone Number:
* Address: Address2:
* City: * State:
* ZIP Code:
* Emergency Contact: * Emergency Phone:
Each conferee will attend two different workshops. Please make one selection for Workshop I and one selection for Workshop II. "Full" workshops are lined out.

Workshop I (9:40 AM - 10:40 AM) *

It's All About me
Jewel Diamond Taylor
Surgical Breast Oncology
Dr. Jessica Rayhanabad
Computer Joint Replacement
Dr. William Long
What Your Teeth Say About Your Body
Dr. Tamara Dixon
Estate Planning
Zoe A. Hamilton
Commit To Fit
Dr. Sophia Momand
Medicare 101
Janice Jimenez
Rheumatology
Dr. Maureen McMahon
Creating & Maintaining Bladder & Vaginal Health
Dr. Cassandra J. Ndiforchu
Aging Gracefully, Skin Care Myths & Facts
TBD
 

Workshop II (10:55 AM - 11:55 AM) *

It's All About me
Jewel Diamond Taylor
Surgical Breast Oncology
Dr. Jessica Rayhanabad
Computer Joint Replacement
Dr. William Long
What Your Teeth Say About Your Body
Dr. Tamara Dixon
Estate Planning
Zoe A. Hamilton
Commit To Fit
Dr. Sophia Momand
Medicare 101
Janice Jimenez
Rheumatology
Dr. Maureen McMahon
Creating & Maintaining Bladder & Vaginal Health
Dr. Cassandra J. Ndiforchu
Aging Gracefully, Skin Care Myths & Facts
TBD
 
I am a Cancer Survivor
I attended this conference in 2015   2016   2017
I have not attended this event before.
Guest of
 
Payment *
Pre-Sale Tickets: $35.00 per person, August 9th - September 13th, 2018
$40.00 per person, September 14th through October 11th, 2018
Cost Includes: Light Breakfast, Lunch & Fashion Show.
Billing Information:
Amount
Address
Billing City
State   Zip
First Name Last Name
CC Number
CVV   ( What is CVV )
Expiration Accepted Credit Cards: Visa, Mastercard, Amex, Discover.

Waivers and Agreements

By agreeing electronically, you acknowledge that you have both read and understood all text presented to you as part of the registration process. Tickets are NON-REFUNDABLE.


Suggested Attire: The Color Pink
Note: Where applicable, if you are under 18, you must be registered by a parent or guardian.
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ABOUT THIS REGISTRATION
There are two ways to register for the conference:
  1. Online:
    This site allows only one person to be registered at a time. Please complete multiple registrations one by one.
  2. At the Field Deputy Office or the Treasurer's Office at Carson City Hall:
    701 E Carson Street, Carson, CA 90745
    Monday - Thursday, 7:00 a.m. - 6:00 p.m.
For more information or registration assistance, please contact:
Sparkale Ross, (310) 952-1711 SRoss@carson.ca.us
Kimberlee Smith, (310) 346-8968 Kimberlee153@outlook.com