CHMS 2019 Conference Registration

Full Name*

First NameLast Name
Professional Designation (Check all that apply)

CCHRSHom(NA)MDMD(H)NDRNHomeopathic StudentOther
"Other" please specify
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Is this your first CHMS conference?*

YesNo
How did you hear about us?

Direct MailEmail from CHMSEmail from otherFacebookFriend/ColleagueCHMS WebsiteOther (please specify)
"Other" please specify
To complete your registration, please click the button below. You'll have a chance to review your form before proceeding to PayPal for payment.

Note: If you do not have a PayPal account, you can use any credit or debit card. On the PayPal site, choose "Pay with a debit or credit card."
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CHMS 2019 Conference Registration: May 17-19, 2019