2022 Dr's Dilemma Registration Form

NYACP Dr's Dilemma Team Registration

Date: Friday, April 1, 2022
Desmond Hotel
Albany, NY

Residency Program
First Name *
Last Name *
Credentials
Office Street Address 1 *
City *
State *
Zip Code *
Email

Registration Fees and Billing Information*
Request for refunds must be made in writing on or before  February 17, 2020  No refunds will be issued after Insert Date. If you have trouble processing your online registration, please contact Karen LaBello by email (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.

Registration Fees *

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Total
Name (As it Appears on Card) *
Billing Address 1 *
Billing Address 2
City *
State *
Zip Code *

Payment Information

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