PLEASE NOTE: advance registration is required. You must also have a current photo ID to attend.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Please provide a day-time phone number where you can be reached?

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* 4. What is your email address?

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* 5. What continuing education credit would you like to receive?

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* 6. Which lecture will you be attending?

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