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Attendee Phone: (required)
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Billing Contact Information (if different)
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Registration Option (required):
$1295 - Individual Member
$1495 - Individual Non-Member
$1995 - Provider Member Group
If you selected a Group attendance option, please list the attendees from your group (name, email, phone)
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NOTE: The AMDIS policy is no refunds but we may offer a substitution or a credit to a future program.
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