Registration online

Saturday,August 14, 2010

First Name:
Middle Initial:
Last Name:
Mailing Address:
Suite:
City:
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Zip:
Country:
Phone:
Fax:
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Credit Card Number:
Expiration Date:	/
Specialty:
Credentials:
Check here if you have special dietary needs:
REGISTRATION FEE
Physicians	$100.00
Nurses, Pharmacists, others	$50.00
Fellows	$50.00
*Industry	$350.00
*Person(s) employed by for-profit organizations such as pharmaceutical and biotech companies, and financial institutions No Refund. Substitution is allowed