January 10, 2018 Member- Guest Dinner & Professional Development Registration Form
You will be able to make modifications after completion of form. If you need to make changes after that, please contact Kay LaDuke at KMLaduke@aaamichigan.com. *** REGISTRATION CLOSES Thursday January 4, 2018 at 6 pm ***
The Skyline Club in Southfield
Registration Information
If you are registering others and you have previously completed your registration, you do not need to register again - just enter the information for those who have not registered.
Are you a Member or Guest *
Required
*If you're a guest, how did you hear about this dinner?
Your answer
Business or Firm Name (enter NA if none) *
Your answer
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Dinner Choice *
Attendee #1 (you'll enter others you are registering for later)
Payment Information
I understand my registration is NOT CONFIRMED until I complete payment. Click on SUBMIT below. * *
Contact Kay at KMLaduke@aaamichigan.com AND Raquel RParlow@bcbsm.com if you request other payment arrangements.
Are you registering for others besides yourself? * *
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