Beck Consulting Mohs Workshop                         October 2024
Event Dates: October 24-25, 2024
Event Address: Avantik Headquarters- 19 Chapin Road, Building C, Pine Brook, NJ
Contact us at (828)369-2315 or at BeckConsulting.us@gmail.com

Below is the Registration Form for a Two-Day Mohs Workshop. This training has been approved for accreditation through the National Society of Histotechnology. 

*A form needs to be completed for each technician registering. Upon receipt of your completed registration, you will receive an invoice via email. Please remit payment for the workshop through the link provided to you. Registration is not complete until payment has been received and confirmed by us.  

Hotel Booking link HERE. We have a block at the Hampton Inn (118 US Highway 46 E, Fairfield NJ) Booking deadline is October 2, 2024. 
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Email *
Mohs Technician Name *
Technician Email Address *
Mohs Surgeon Name *
Office Name *
Office Address *
Office Phone Number *
Full Name (as you want printed on certificate & badge) *
Best Contact Number (in case we need to reach you during your travel and stay)  *
Will you be staying at the Hotel with us? *
Will you be using the shuttle to and from the hotel & workshop? *
Emergency Contact Name *
Emergency Contact Number *
Do you currently work in a Mohs Lab? *
How long have you been cutting Mohs? (write "N/A" if not applicable)  *
How many estimated cases do you cut a day? (N/A if not applicable) *
Do you have any dietary restrictions? *
If you chose "other" above, please briefly describe: 
Registration fee is $1200 per tech. If more than one is registered per office, a discount of $100 per tech will be applied to the invoice. 
Invoicing Information Needed: Please provide Contact Name, Contact Email & Contact Phone  *
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