PERQUE

PERQUE is sold
through doctors
and healthcare
professionals only.

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* indicates a required field.

First Name *
Last Name *
Sex * M F
Professional Credentials*
Clinic/Organization *
Office Address *
City * State * Zip Code *
Phone * Fax *
Email (for Seminar Correspondence Only) *

Please indicate the seminars you plan to attend: *
March 8, 2007 in Houston, TX with Steve Steeves, CCN and Amy Steeves
April 4, 2007 in Virginia Beach, VA with Robert Nash, MD
May 3, 2007 in Annapolis, MD with Ingrid Kohlstadt, MD
June 6-7, 2007 in Chicago, IL with Brian McGuckin, DC and Frank Strehl, DC
September 26, 2007 in Northern Virginia with Alan Vinitsky, MD
October 11, 2007 in Wilmington, DE with Donald Feeney, DC
October 25, 2007 in Milwaukee, WI with Norm Schwartz, MD
November 15, 2007 in San Antonio, TX with Faculty TBD