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Meeting Registrations * = Required Field
If you are already registered and would like to make changes, please find your registration to continue.
Primary Registrant Information
Prefix First Name Initial Last Name Suffix
* *
Badge Name: * Please do not use all capital letters.
 Update my personal record with the phone and fax numbers below.
Phone #: * (###-###-####) for U.S numbers
Fax #: (###-###-####) for U.S numbers
 Update my personal record with the email address below.
Email: *  
Secondary Email Address:
 Update my personal record with the information below.
Organization 1:
Organization 2:
Address 1: *
Address 2:
City / State / Zip: * *
Country:
Type:
Registration Type: * View Type Information
Registration Fee:
Register Spouse/Guest:
 
Additional Information
Please enter your NPI:
* for Sunshine Act compliance
Please select the job category or categories best related to your job description: *
 Aesthetic  Management  Reconstructive
If you or an accompanying person require special accommodations to fully participate, please describe your needs:
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License Number

 
*

State of License

 
*

How many years in practice

1-5 5-10
10-15 20+
 
*

In what type of office setting do you practice nursing?

Ambulatory Hospital
Physician's Office Other
 

Please provide practice setting type if not listed above.

 
*

Is this your first meeting?

Yes No