7th CURED Patient Education Research Conference Registration for Medical Professionals, & Pharmaceutical Partners "*" indicates required fields Name*This will be the name you will give to the registration desk. First Last Suffix Company/Medical Center Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Please provide a number that you will be reachable at during your attendance to the CURED conference.Email*Please provide an email through which CURED can effectively communicate with you regarding all CURED conference materials In Person AttendeesThe attendee price includes admittance, breakfast and lunch for Thursday – Sunday. Number of Attendees Virtual onlyOne Attendee - $150Two Attendees - $300Three Attendees - $450First attendee will attend these days:* Thursday Friday Saturday Sunday Select AllSecond Attendee Name* Second attendee will attend these days:* Thursday Friday Saturday Sunday Select AllThird Attendee Name* Third attendee will attend these days:* Thursday Friday Saturday Sunday Select AllRegular Meals*Gluten Free MealsBringing MealsVirtual Only AttendeesChoosing this option will allow you to view the conference in Real-Time (EST) and you will receive the recording post the event. *Links are not shareable*Number of Virtual Attendees none1 url for viewing - $1252 urls for viewing - $2503 urls for viewing - $375Email for virtual link Email for second virtual link Email for third virtual link DonationsAdditional Donation Coupon Code Total Payment MethodPayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.
