"Minorities in Medicine: Past, Present Future ”
SNMA Region IX Annual Conference
SUNY University Medical School
Student Pre-Registration Form
Prefix Mr Mrs Ms Dr
First Name
Middle Name
Last Name
SNMA Membership # (if applicable)
Address
City
State
Zip
Country
Email
Phone
Fax
School/Business Affiliation
Title/Occupation
Registration Fee

Regular Registration

Medical Student Regular Registration (SNMA Member): $35.00
Pre-Med/Undergrad Student Regular Registration (SNMA Member): $20.00
Post Bacc Student Regular Registration (SNMA Member): $35.00

Medical Student Regular Registration (Non-Member): $40.00
Post Bacc Student Regular Registration(Non-Member): $40.00
Pre-Med/Undergrad Student Regular Registration(Non-Member): $25.00

Additional Cost Kaplan Practice MCAT: $5.00
Jazz Mixer Tickets: $5.00
Contribution Amounts