Graduate Refresher Course

Edward Hotel Chicago, Rosemont, IL
24-25 August 2019

In addition to completing this form, the following items are required for your application to be considered.
  • Scan of your current medical license
  • Tuition payment
The fields indicated with an asterisk (*) are required.

    Name And Professional Information

    Contact Information

    Home Address:


    Indicate course(s) you are applying to:*

    Graduate Refresher Course Only: $1250($1400 after August 1)CSA and Graduate Refresher Course: $1700($1900 after August 1)

    Indicate method of payment:*

    CheckPreferred - Payable to Helms Medical Institute, 2520 Milvia Street, Berkeley, CA 94704Credit Card - onlinePay online at Card - by phoneCall 510-649-8488 between 9:00 AM and 2:00 PM Pacific Time or fax to 510-649-8692

    All training activities will take place at the Edward Hotel Chicago (Rosemont, IL) where a group rate of $112 (plus 14% occupancy tax) has been arranged. Reservation information will be provided upon acceptance to the course.
    For additional information about this course, call 510-649-8488 or e-mail