TABLE REGISTRATION
Please fill name and contact information of attendees.
Your Name
First Name
Last Name
Title (MD, DO, etc.)
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
I would like to purchase the following table(s):
(1) Table of 8 - $1,000.00
(1) Table of 10 - $1,250.00
(2) Tables of 8 - $2,000
(2) Tables of 10 - $2,500
Custom Table Option - (Table of 4 or 6 only). Please list how many seats you would like. Tickets are $150.00 each.
Please list all attendee names and titles, if applicable (MD, DO, etc). If guests are not idenitified at this time, please list TBD and email Nadine Popovich at npopovich@acms.org with attendee names by November 1, 2024.
Are you attending to celebrate a specific awardee? If so, who?
Billing/Invoicing - Please provide the name and email of the person who should receive this invoice. If you are unsure, list TBD and an ACMS Staff Member will reach out to you.
Questions?
Contact Elizabeth Yurkovich at
eyurkovich@acms.org.
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