LWP November 2024

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November 15-16, 2024
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.

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SELECT YOUR TICKET
Please choose your registration ticket

Additional Tickets will be available on the next page
Registration Ticket*

DC - $440First Year Doctor - $250Student - $75

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ADDITIONAL TICKETS
Additional Tickets
Associate DC - $250
Maximum of 3 Associate DC can be added.
Team Member - $150
You only need 1 ticket for 3 Non-DC Team Members
Student - $50
Maximum of 3 Student Tickets can be added.
Ticket Counter

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ADDITIONAL INFORMATION
Please fill the additional information for your Additional Tickets
Associate DC 1 Name

First NameLast Name
Associate DC 1 Email
example@example.com
Associate DC 2 Name

First NameLast Name
Associate DC 2 Email
example@example.com
Associate DC 3 Name

First NameLast Name
Associate DC 3 Email
example@example.com
Team Members
Student 1 Name

First NameLast Name
Student 1 Email
example@example.com
Student 2 Name

First NameLast Name
Student 2 Email
example@example.com
Student 3 Name

First NameLast Name
Student 3 Email
example@example.com
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COMPUTATION PAGE SKIP THIS
Admission Ticket
Admission Ticket Final
Associate DC Total
Associate DC Price
Associate DC Text Value
Associate DC Text
Team Member Total
Team Member Price
Team Member Text Value
Team Member Text
Team Member Final
Student Total
Student Price
Student Text Value
Student Text

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PRE-REGISTRATION CHECKOUT
Discount Code
Subtotal
Discount Value
After Discount

REGISTRATION DETAILS

Main Ticket:

{admissionTicket}{admissionTicket81}

Add-Ons:

{associateDc36}{associateDc37}{associateDc35}

{teamMember80}

{studentText}{studentText45}{studentPrice}

Total

USD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: