LMOA Registration/RSVP

May 15 - Wellbeing in the Medical Office

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* 1. Because we care about your wellbeing and your time, we have decided to also offer this month's meeting virtually via live stream on Teams. Whether you join us in person or virtually, the $20 charge per person will apply.

Will you be joining us for lunch at the Courtyard or viewing it virtually?

I'll be joining in-person at the Courtyard

I'll be joining virtually and request the meeting link to be sent to my email address listed below.

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* 2. Guest #1: Last name, First name (example: Doe, Jane)

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* 3. Guest #2 (if applicable): Last name, First name

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* 4. Guest #3 (if applicable): Last name, First name

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* 5. Guest #4 (if applicable): Last name, First name

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* 6. Practice Name or Department Name:

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* 7. Contact person's email address:

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* 8. Lunch Fees

I understand that my luncheon / live stream cost will be $20 per person if I'm registering before the Friday noon deadline.

I understand that my luncheon / live stream cost will be $30 per person if I'm registering after the Friday noon deadline.

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* 9. Payment Method - Payment is expected on the day of the event.

I will pay at the door via a check to LMOA

I will pay cash at the door (exact change only please)

I will mail in my payment in advance to LMOA, PO Box 144, Stevensville, MI 49127

I work for Corewell Health South and will provide my Company Code and Cost Center number so you can invoice my department directly through Workday

LMOA Registration/RSVP

May 15 - Wellbeing in the Medical Office

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* 2. Guest #1: Last name, First name (example: Doe, Jane)

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* 3. Guest #2 (if applicable): Last name, First name

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* 4. Guest #3 (if applicable): Last name, First name

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* 5. Guest #4 (if applicable): Last name, First name

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* 6. Practice Name or Department Name:

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* 7. Contact person's email address:

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* 8. Lunch Fees

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* 9. Payment Method - Payment is expected on the day of the event.

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* 10. I chose payment method #4, so my Corwell Health South Company Code is:
(example: CO_013, CO_014, etc.)

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* 11. I chose payment method #4, so my Corewell Health South Cost Center is:
(example: CC12345)

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* 12. Comments, questions, special dietary requests, etc.

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* 2. Guest #1: Last name, First name (example: Doe, Jane)

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* 3. Guest #2 (if applicable): Last name, First name

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* 4. Guest #3 (if applicable): Last name, First name

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* 5. Guest #4 (if applicable): Last name, First name

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* 6. Practice Name or Department Name:

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* 7. Contact person's email address:

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* 8. Lunch Fees

Question Title

* 9. Payment Method - Payment is expected on the day of the event.

Question Title

* 10. I chose payment method #4, so my Corwell Health South Company Code is: (example: CO_013, CO_014, etc.)

Question Title

* 11. I chose payment method #4, so my Corewell Health South Cost Center is:(example: CC12345)

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* 12. Comments, questions, special dietary requests, etc.

* 10. I chose payment method #4, so my Corwell Health South Company Code is:
(example: CO_013, CO_014, etc.)

* 11. I chose payment method #4, so my Corewell Health South Cost Center is:
(example: CC12345)