International Multiple Sclerosis Management Practice

MS 2010: 20/20 Vision on 10/10/10

Sunday, October 10, 2010

8AM to 1PM

Hilton New York

Register Early!!

Full Program to Follow

Name:

Address:

Address Line 2:

City:

State:

Zip Code:

Phone:

E-Mail:

How many people other than yourself will accompany you?

Name of Guest #1:

Name of Guest #2:

Name of Guest #3:

Are you a patient of :

Dr. Sadiq	Dr. Sylvester	Dr. Williams	Dr. Stark
I am not a patient at the IMSMP

If you are not a patient at the IMSMP, how did you hear about the symposium?:

A brochure was mailed to me	Newspaper
Friend Referral	Other: