7th CURED Patient Education Research Conference Registration for Medical Professionals, & Pharmaceutical Partners"*" indicates required fieldsName*This will be the name you will give to the registration desk. First Last Suffix Company/Medical CenterAddress* 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 AttendeeIn Person or Virtual AttendeeOne Attendee - Virtual - $125One Attendee - In Person - $150Will attend these days:*The In Person attendee price includes admittance, breakfast and lunch for Thursday – Sunday. Thursday Friday Saturday SundaySelect AllRegular MealsEmail for virtual link*"Virtual Only" links are for one person only and are not shareable. Each virtual attendee must fill out a separate registration form. Virtual links provide viewing in Real-Time (EST) and a recording after the event. Choose Type of Breakfast* Regular meals Gluten free meals Bringing my ownChoose Type of Lunch* Regular meals Gluten free meals Bringing my ownDonationsAdditional Donation Coupon Code Total Payment MethodPayPal CheckoutCredit CardMasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.