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REGISTRATION FORM


First Name
Last Name
Street Address
City, State, Zip
Phone
Email Address

Select one:

Accreditation






REGISTRATION FEES

Fees

Request vegetarian lunch.

PAYMENT

Select payment:

Refund and cancellation policy: A refund will be made if notice of cancellation is received 10 business days prior to the event. Springfield Clinic reserves the right to cancel or substitute speakers or topics.