Choose the seminar that you are attending from the list below, fill in the requested information, and submit your registration.

Ohio Region Future Ohio Region Reconstructive Surgery Seminar 2009-04-18 - 9:00 AM - Barix Clinics of Ohio - 3964 Hamilton Square, Blvd, Groveport, OH 43125         First Name  * required Last Name  * required Email  * required Phone (xxx)xxx-xxxx  * required Zip Code  * required Number Attending Seminar 1 2 3 4 5 Additional Information We'd like to know a little more about you so that we can customize our seminar to your needs and assist you in understanding your insurance plan's benefit coverage.   Health Insurance Company Date of Bariatric Surgery (mo/year) Weight Lost (pounds) Gender M F Questions or Comments Regarding This Seminar                 PRIVACY PLEDGE:  We respect your privacy.  Your personal information will only be used to help determine if our program may help you and will NOT be shared with other organizations.