APT August Conference - Individual Registration

2025 Arizona Perinatal Trust Annual Conference

Individual Registration
Name*

First Last Credentials
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone

Area CodePhone Number
Affiliation*
Health System, Organization, Hospital, Company
Title
Are you seeking CEUs or CMEs*

YesNo
Professional License # *
Please indicate how you would like your name printed on your badge*
Please indicate how you would like your name printed on your badge*

Same as listed aboveOther
Can we include your name on our Attendance List?*

YesNo
Registration Fees and Payment
Payment Type*

CheckCredit card
When you click "Submit Registration," you will receive a confirmation email with instructions for mailing your check.
When you click "Submit Registration," you will be redirected to the PayPal login.

IF YOU HAVE a PayPal account, select the "PayPal Checkout" to login and complete your payment.

IF YOU DO NOT HAVE a PayPal account, select either the "Checkout" button to pay with a credit or debit card or the "Venmo Checkout" button to pay via Venmo.
My Products*
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Credit Card Registration Fee$250.00
No refunds will be made after 7/31/2025. "No Shows" are still due and payable in full, as meals and conference materials are purchased based on your registration. For registration questions email apt@azperinatal.org.
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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Registration Fees and Payment