2021 MEAC/Premier Spring Clinic Registration Form

2022 MEAC July Clinic Registration Form
Registration Instructions: A red asterisk (*) indicates that the field is required. You must enter data and cannot leave it blank.
Full Name *

First Name Last Name
Select the appropriate registration option
One Time Full Payment

$300
1st Half 50/50 Payment

$150
2nd Half 50/50 Payment

$150
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number 1 *
Phone Number 2
E-mail *
example@example.com
Conferences Affiliation(s) *
Payment Type *

CashApp PayPal Credit/Debit Card
You have selected to pay via CashApp. You can submit the registration form and CashApp the money to $Premierofficial.
You have selected to pay via PayPal, Credit or Debit card.

A 3% processing fee will be added to all Transactions. Once you submit the registration form, you will be taken to the PayPal login screen where you can login and pay via PayPal or enter your credit or debit card information.
Calculation
Total Payment

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