Free Seminar Registration

Complete the form below to register to attend a free educational seminar with Dr. Kaplan.

When your information has been received and processed, you will receive confirmation of the class date that you have been scheduled for. Cancellations are rare, but do occur. In the event of your chosen seminar date being cancelled, you will be notified. If you have any questions, please contact Dr. Kaplan's office at 304.865.4345.

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Email Address *

Telephone *

Choose a Seminar*
(Please select two dates in
order of preference due to
cancellations, limited
seating, etc.)

First Choice

Alternate Date

Gender *

Age *

Height*

FT IN

Weight*

LBS

Your BMI

Unsure about your BMI? Click here.

Current Weight-Related
Health Issues (if any)

Primary Care Physician
(if any)

Surgery Cost
Payment Method*

I would like confirmation
on my registration by*

How did you hear about
Dr. Kaplan?
(check all that apply)

	Television
	Radio
	Outdoor Advertising
	The Web
	Physician Referral
	Other (Friends, Family, Co-Workers, etc.)

Fields marked with * are required.

Discover basic information on the Lap-Band Adjustable Gastric Banding System.

View Dr. Kaplan's extensive surgical experience and credentials.