2019 Resident and Medical Student Forum Attendees Registration Form

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NYACP Resident and Medical Student Forum
Saturday, February 23, 2019

Desmond Hotel
660 Albany Shaker Road
Albany, NY  12211

Program Topics

  • Poster Competition
  • Dr's Dilemma Competition

 

 

ACP Membership #
First Name *
Last Name *
Credentials
Address *
City *
State *
Zip Code *
Office Phone *
Office Fax
Email
Registration Fees *

Clear Selection
Total

Registration Fees and Billing Information*
Request for refunds (less any processing fees) must be made in writing on or before Insert Date.  No refunds will be issued after Insert Date. If you have trouble processing your online registration, please contact Karen Tucker LaBello at klabello@nyacp.org or contact the NYACP office at (518) 427-0366.  Contact Us      Privacy Policy     Site Map   
 

*You must list exactly the address your monthly cardholder statements are sent.

Name (As it Appears on Credit Card) *
Billing Address 1 *
Billing Address 2 (ie Apartment, Floor, Suite, etc)
City *
State *
Zip Code *

Payment Information

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