Registration

* 1. Name

* 2. ACP Number

* 3. My Registration is for:

* 4. Chapter

* 5. Year your Board Certificate expires (Members) / Year you plan to take boards (Resident Members: IL Elite Status ONLY):

* 6. How many times have you recertified in the past?

* 7. Email address:

* 8. Cell Phone (used only in case of emergency prior to a session):

* 9. Mailing Address:

* 10. * IL Resident Members ONLY: I am an Resident Member at one of the following Elite Status Residency Programs (Masters, Fellows, & Members can skip to the next question):

* 11. How did you hear about MKSAP Live Online Study Hall?

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