Language
English (US)
MASAM SUD Pearls for Practice. Visions of Addiction Treatment 2022: How can we do better?
Online monthly series starting Tue. January 25, then the 3rd Tuesday of each month (Feb-Jun). Please complete the form below and select your registration category. All fields marked * are required.
Full Name
*
First Name
Middle Initial
Last Name
Title
(e.g. MD, PA, RN) or leave blank
Address
*
Street Address
Street Address Line 2
City *
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State *
Zip Code *
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
1. MASAM members, Fellows, Residents and Students register here
Select type here
Physician
Associate
Fellow
Resident
Student
Membership category selection
2. Non-members register here
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next
( X )
Non-Members (fee varies from $0-$100)
$
100.00
Please select your registration category and your price will be displayed.
Please select type
Physician
Allied Health professional
Total
$
0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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