Register for Seminar

To register for seminar, please enter the information and press the “Send” button when you are through.

(*) Your name and phone number or email are required fields, so that we can contact you to confirm your appointment

Please fill out the form below with as much information as possible, this will help us expedite the processing of your information.

If you have any questions or concerns regarding the registration form, please contact our office at 631-689-0220.

 

Contact Information
  • First Name *
  • Last Name *
  • Date of Birth
  • Contact Number *
  • E-Mail Address *
Personal Health Details
  • Reason for your appointment:
  • What is your height? feet Inches
  • What is your weight? lbs
Insurance Information
  • Do you have Health Insurance: YesNo
  • Insurance Carrier:
Seminar Date
  • Seminar date



Unless otherwise noted, Seminars are held in the LIAP Conference Center, located in the Arthur & Linda Calace Foundation Pavilion. Please enter through the Cody Ambulatory Pavilion, 625 Belle Terre Road. *This is not the main entrance of the Hospital.

Seminars marked with (*) will take place at our Riverhead Location:

Holiday Inn Express, 1707 Old Country Road, Riverhead.