Make your own free website on Tripod.com

Seminar Online Order Form

Download printer friendly order form here    

Please circle the course # you want to review

Course 111 WORKERS' COMPENSATION APPORTIONING DISABILITY TO CAUSATION 
                 
By Stuart Green, M.D.                                                             3 hours credit         $100

 Course 112 MEDICAL OPINION AS EVIDENCE: “THE JUDGE’S PERSPECTIVE”   
                    By Judge William Ordas                                                    1.5 hours credit         $50

 Course 113 NEW APPORTIONMENT LAW Part 1   by Judge Mark Kahn
                                                                                                                6 hours credit          $180

 Course 114 NEW APPORTIONMENT LAW Part 2   by Judge Mark Kahn
                                                                                                                6 hours credit          $180

 Course 115 SUBSTANTIAL MEDICAL EVIDENCE IN AN AMA GUIDES CASE
                      By Robert Rassp, ESQ                                                       3 hours credit          $100

                                                                                                             TOTAL             ___________

 Circle specialty you are recredentialing            QME                 Attorney           Claims Professional

 ____________________________________________________________________________________
Name                                                   Address                       Print clearly

 ____________________________________________________________________________________
phone #                                                Fax#

  E-mail address  _________________________  @  ______________________

Circle one                    Fax my certificate ( faster)        Mail my certificate

Payment           circle one         Check enclosed            credit card info below

 Make check payable too:  Goldenstate Enterprises

 Master/visa       __ __ __ __   __ __ __ __ __ __   __ __ __ __ __  exp ___/___

 _____________________________________                          _______________________________

Print name on card                                                                  Signature

FAX to:    206-222-2691  Secure fax

Or

Mail to:

Goldenstate Enterprises
17586 Via Loma Dr
Poway  CA  92064

Download printer friendly order form here        
Download reader if you have trouble viewing