Name:_____________________________________________________ 

Bar#:_______________________

Firm:______________________________________________________ 

Address:___________________________________________________

City:_________________________________  State:_____________  

Zip:________________


Tel:(_____)___________________________

Fax:(_____)__________________________



_____YES! I will attend the "Understanding Medical Malpractice
     and Maximizing Recovery In All Medical Malpractice and
     Personal Injury Cases."

_____I am interested in upcoming Seminars.

Enclosed is my check for $______________
($450 per person) payable to: Medical Review
Foundation, Inc.

or

              To register by phone: Call 800-336-0332.

              Seating is limited to only 50 attendees.     

*** Group/firm discounts available.

Refund Policy: With 30 days notice a full refund will be made. 
With less than 30 days notice, full credit toward attendance at
any other Understanding Medical Malpractice Seminar will be
issued.

_____ No, I can't attend your seminar, however, I am
      interested in:

_____ Information on your services; please send
      to the address above.

_____ I have a case I would like to discuss with your Medical
      Director. Please have him call me at the number above
      for my telephone Case Evaluation.


My Medical Malpractice area(s) of interest are: 

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________