Reservations

Instructions

Please fill out the following form, fax it to us at: 1-954-771-1134 and a Customer Service Agent will contact you regarding your CME Trip.

Alternatively, you may mail us this form at:

Professional Travel Abroad, Inc.
2929 East Commercial Blvd
Suite 201
Fort Lauderdale, FL 33308
U.S.A.

Kindly register with your name exactly as it reads on your passport.

Download Printer Friendly Registration Form

Tour Information
CME Tour

Departure Date

Personal Information
Name
Address
City
State
Postal Code
Phone
Medical Specialty
Email Address

Accompanying Person
Name
Address
City
State
Postal Code
Phone
Medical Specialty
Email Address

Credit Card Payment Information
Name on Card
Card Number
Card Type

AMEX VISA Master Card

Exp. Date

CME Program Registration is $295 per person. There will be persons attending. Please charge my deposit of $ on my credit card.
Credit Card Signature

Check Payment Information

Enclosed please find my check made payable to Professional Travel Abroad for $(USD) representing my deposit of $300 per person or $750 per person for cruise programs.

Terms of agreement

By sending this form, I understand and accept the terms and conditions outlined on this website.