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AAAP 2007 Review Course 

Registration Form

 

Personal Information  
First Name:  
Last Name:
Degree(s):
Organization/Company:
Address 1:
Address 2:
City:
State:
Zip/Postal Code:
Country:
Web Site:
Work Phone:
Fax:
E-mail:
Emergency Contact Phone:
Membership Status Yes                 No
Registration fees (check appropriate)
     
Member Physician   $275  
Nonmember Physician   $325  
Resident/Medical Student   $200  
Related Health Professional   $200  
     
     
   
  How did you hear about the AAAP Review Course?
 
AAAP News
AAAP Web Site
Colleague
Advertisement
AAAP Mailing
Other
   
Billing Information
Click here if billing information is the same as contact information.
Billing First Name:
Billing Last Name:
Billing Address 1:
Billing Address 2:
Billing City:
Billing State:
Billing Zip:
Billing Country:
 
Payment  
Card Number:
Expiration Date:
CSV Code:

  On the back of your credit card, you should see three digits that are not part of your credit card number. These three digits are your Card Security Verification (CSV) number.

      

 

Cancellation Policy

50% of the total registration fee will be refunded if cancellation is necessary and a written notification is received by AAAP by November 1, 2007. After that date no further refunds will be approved. All approved refunds will be issued after the meeting.