2020 IFSER Educator's Summit Registration
Email address *
July 24th & July 25th Costa Mesa, California
Hosted at Orange Coast College
Attendee's First Name *
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Attendee's Last Name *
Your answer
Mailing Street Address *
Your answer
City *
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State *
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Zip Code *
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E-Mail Address (for emailing your CME's) *
Your answer
ARDMS #
Your answer
SDMS #
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CCI #
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Phone Number *
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Date of Birth (for CME's) *
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YYYY
Hotel name/location will be announced soon. Will you be staying at the hotel chosen by IFSER? *
Please indicate the days you plan to attend: *
Required
Will you be using the PayPal link provided on the 2020 Educator's Summit page at www.IFSER.org or mailing a check? Mail Check To: P O Box 132168 Tyler, TX 75713 *
To assist us in tracking registrations, please indicate the name of the person or organization who will be making the payment for this attendee. (If self, please state "self") *
Your answer
What college or hospital are you from or representing include City and State? *
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NOTE: Breakfast, Lunch, 2 breaks each day will be provided. Social/Networking with food/beverages will be provided Friday night. For special food allergies, please plan accordingly. Thank you. *
A copy of your responses will be emailed to the address you provided.
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