Patient Fertility Conference in Westchester
The Conference is designed for adults only; no child care provided.
All fields with ( * ) are required.
* Name (Person 1): 
* CWRC Patient: Yes   No
Name (Person 2): 
CWRC Patient: Yes   No
* Address:
* City:
* State:
* Zip:
* Email:
* Fax:
* Work Phone:
* Home/Cell Phone:
* How did you learn about the Conference?

Workshop Selections:
Participants will be able to attend up to three workshops in the Conference. Please select up to five topics and indicate the order of preference in the appropriate box. Check the boxes below to indicate your preferred topics (for example: Number “1” = first choice, number “2” = second choice, etc.)
Person 1
 IVF/In Vitro Fertilization
1  2  3  4 5
Oocyte (Ovum, Egg) Donation
1  2  3  4 5
PGD (Pre-implantation Genetic Diagnosis)
1  2  3  4 5
The role of an OBGYN in the evaluation and treatment of infertility
1  2  3  4 5
Male Fertility
1  2  3  4 5
Pre-Conception Screening and Planning
1  2  3  4 5
Acupuncture and Infertility
1  2  3  4 5
The Spiritual Challenges of Infertility
1  2  3  4 5
Enhance your Fertility, Transform your Life
1  2  3  4 5
Financing Infertility Care: In network VS out of network
1  2  3  4 5
Person 2
 IVF/In Vitro Fertilization
1  2  3  4 5
Oocyte (Ovum, Egg) Donation
1  2  3  4 5
PGD (Pre-implantation Genetic Diagnosis)
1  2  3  4 5
The role of an OBGYN in the evaluation and treatment of infertility
1  2  3  4 5
Male Fertility
1  2  3  4 5
Pre-Conception Screening and Planning
1  2  3  4 5
Acupuncture and Infertility
1  2  3  4 5
The Spiritual Challenges of Infertility
1  2  3  4 5
Enhance your Fertility, Transform your Life
1  2  3  4 5
Financing Infertility Care: In network VS out of network
1  2  3  4 5

top