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Intensifying Diabetes Management Registration Form

 

Please fill in the registration form below to pay through Paypal.

Please indicate your profession:
Profession Please select one








Contact Information
Workshops
Please select the workshop(s) that you will be attending:  
Payment Amount
Registration Fees Fees
I am attending One day $125.00
I am attending Two days $250.00
I am attending Three days $375.00
I am attending Four days $500.00

  

I will be submitting the following fee:  




I will be paying my fees: