MOCA® Registration Form Administration
Personal Information
First Name
 *
Middle Initial
Last Name
 *
Credentials
Street
City
*
State
 *
Zip Code
 (numerics only please)
Country
Cellular Phone Number
 *
Email Address
 *
Dietary restrictions:


Professional Information
ASA Number
ABA Number
ABA Expiration Year
Institution where residency program was completed
Current Institution
Subspecialty (if any)
Have you previously attended the MOCA Course at the University of Miami?

A minimum of 12 months is required between courses.

If yes, when?    

If uncertain, leave blank.
 


Available Course Dates
Select date:



Name badge
All participants will be provided a name badge to wear on the course date.

If you would prefer for your name to appear differently on the badge, please let us know by completing the fields below. Otherwise, please skip this section.
Badge First Name
Badge Last Name


Registration Terms
Cost per person: $1950
Discount price: $1700 for graduates of the UM-JMH Anesthesiology Residency Program and for returning University of Miami MOCA participants.
Note: The seating per class is limited.
Cancellation/Refunds: Cancellations may be made with a full refund, minus a $250 processing fee. Cancellation requests must be made via email to Roxanna Araya no later than 30 days prior to the course date. Cancellations received less than thirty days prior to event will not be refunded. Switching Course Dates: All requests must be made via email to Roxanna Araya at least thirty days prior to the course date. If the request is received less than thirty days prior to the event, the registrant will be required to pay for the new course date and will receive a 50 percent refund for the initial course. If the vacated spot is filled, the registrant will receive a full refund for the initial course minus a $250 administrative fee.
Contact us: If you have any questions or conflicts contact Roxanna Araya via email at raraya@med.miami.edu


Payment Information

  Discount: Alumni or returning MOCA course participant.    

Please select payment method: