Board Review Course Registration Form
Name
First Name
Last Name
E-mail
example@example.com
Are you an ACP Member?
Yes
No
What state are you in?
ACP Member Number (Required to receive ACP member pricing)
Registration
Please note - if you are registering an entire program, please select the quantity below and email us the attendee list to liz@aminc.org.
Registration Levels
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next
( X )
ACP Member - New Graduate
Since July 2023
$
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Item subtotal:
$
0.00
Non-Member: New Graduate
Since July 2023
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
ACP Member
$
300.00
Quantity
1
2
3
4
5
6
7
8
9
10
Non-Member
$
400.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: