Get Registration Form For Faxing - Nyu Langone Medical Center

Filling out the Registration Form for Faxing at NYU Langone Medical Center is a straightforward process. This guide provides clear instructions for each section of the form to ensure users can complete it efficiently and accurately.

Follow the steps to successfully complete the registration form.

1. Click ‘Get Form’ button to retrieve the registration form and open it in your preferred editing program.
2. Begin by filling in your personal information clearly. This includes your name, address, city, state, zip code, daytime phone number, email address, degree, and specialty. Remember, the email is crucial for receiving confirmation.
3. Indicate your payment method. You may choose either to pay by check or credit card. If using a credit card, fill in the card member’s name, card number, expiration date, and the amount to be charged. Ensure you provide a signature to authorize the payment.
4. Select the registration fees you are eligible for by checking the appropriate boxes. Be aware of criteria for discounted fees if applicable.
5. If you have individual dietary restrictions, please note them in the designated area to ensure proper accommodations.
6. After completing all sections, review your form for accuracy. Once confirmed, you have the option to save the changes, download, print, or share the completed form before sending it.
7. Finally, fax the completed registration form to the designated number: (212) 263-3959.

Complete your registration form online today to secure your place in the program.