Attendee Information
Name
*
First Name
Last Name
MD/DO/Other
*
Professional Title
*
Organization
*
Attendee Contact Information
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Please list any dietary restrictions
Allergies, Celiac, Vegetarian, Etc.
Terms & Conditions
By registering for this event, I give consent for my image or voice to be used for marketing purposes including but not limited to digital and print materials. If you do not wish to have your photo taken, please contact WCMS Staff.
*
I understand that my image or voice may be used for marketing purposes, including but not limited to digital & print materials.
Registration Types
*
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WCMS Member Registration
Registration for members of WCMS.
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
WCMS Member Guest
Registration for guest of a WCMS member
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
WCMS NON-Member
Registration for non-members of WCMS.
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Guest Registration
Name
First Name
Last Name
MD/DO/Other
Please list any dietary restrictions
Allergies, Celiac, Vegetarian, Etc.
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Submit
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