Symposium Registration - Step 1

Nurse / Allied Medical Personnel Registration

Degree(s): MD PharmD PhD RN - Other

Last Name*

First Name*

M.I.

Address*

City*

State**

Zip* (0 if none)

Country*

Affiliation

Office Phone*

Home/Mobile Phone

Fax Phone:

(Please include country and city codes: xxx-xxx-xxxx)

Email*

(For confirmation of registration, payment and individual CME survey access)

Specialty or Area of Practice:

 

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REGISTRATION FEES

$99

1. Early-Bird On or before January 3, 2022

$129

2. Pre-Registration January 4 - February 3, 2022

$129

3. After February 3, 2022

Only Visa, Mastercard, Amex and Discover accepted.

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