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 Phone:

Fax Phone:

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

Email*

(For confirmation of registration and payment - name@domain.com)

Specialty or Area of Practice:

 

*Fields with *asterisk are required.
**Fields with **asterisk are required in the United States.

 

OPTIONAL INDUSTRY SESSIONS

Product Theatre sessions require RSVP's. Please indicate below if you plan to attend any of
Saturday's sessions. (All are non-CME)

Breakfast Session Product Theatre (non-CME). Hot breakfast will be provided to those that
attend. This session requires a RSVP. Please indicate below if you plan to attend.

YES, I will attend the Product Theatre Breakfast Session
              Speaker and Title TBA
              Supported by Janssen Pharmaceuticals, Inc.
              7:00-8:00am on Saturday, April 21 (non-CME)

Lunch Session Product Theatre (non-CME). Lunch will be provided to those that attend. This
session requires a RSVP. Please indicate below if you plan to attend.

YES, I will attend the Product Theatre Lunch Session
              Speaker and Title TBA
              Supported by Novartis Pharmaceuticals Corporation
              12:35-2:00pm on Saturday, April 21 (non-CME)

 

REGISTRATION FEES

$100

1. Early-Bird On or before February 26, 2018

$120

2. Pre-Registration Feb. 27, 2018 - Apr. 1, 2018

$130

3. Registration After April 1 and On-site

Only Visa, Mastercard, Amex and Discover accepted.
Mail in Option also available.

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