TSL Web Reg

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Tickets
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If you select the student option, you must be a current PA student; all student activities occur on Friday and Saturday of the conference

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Bringing a guest? Guests are welcome at evening events and activities, but will not be admitted to CME-related activities. You may register a Guest in the Paid Workshops and Tickets page in a later step. You may purchase a guest ticket for all evening activities or a single function.

Description	Price $	Add. Reg. Price $	Guest Price $
Member Full Conference	$	$	$
Full Conference + Membership Dues	$	$	$
Member Wednesday Only	$	$	$
Member Thursday Only	$	$	$
Member Friday Only	$	$	$
Member Saturday Only	$	$	$
Member Wednesday Only + Membership Dues	$	$	$
Member Thursday Only + Membership Dues	$	$	$
Member Friday Only + Membership Dues	$	$	$
Member Saturday Only + Dues	$	$	$
Non Member Full Conference	$	$	$
Non Member Wednesday Only	$	$	$
Non Member Thursday Only	$	$	$
Non Member Friday Only	$	$	$
Non Member Saturday Only	$	$	$
Student Member	$	$	$
Student Non Member	$	$	$
Full Conference + Membership Dues	$	$	$
MEMBER Two Day Registration	$	$	$

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First Name *
Last Name *
Credentials
Company
Address 1
Address 2
City
State
Zip
Address Type
Phone
Email *

Additional Registrants

First Name *	Last Name *	Email *	Amount $

Guests

First Name *	Last Name *	Title	Phone	Email *	Amount $

Workshop and Tickets Options

Description	Price $	Qty	Total $
Advanced EKG Workshop with Tim Phalen-Thursday
Suture Workshop-Friday

All Access Guest Pass-Includes all social activites
Guest Name
Guest Ticket for Welcome Reception-Wednesday
Guest Name
Guest Ticket for Trivia Night-Thursday
Guest Name
Guest Ticket for Band Party-Friday
Guest Name
Guest Ticket for Challenge Bowl-Saturday
Guest Name

Discount Code

	Code:

Payment Information

Pay by Credit Card

Payment is expected in order to confirm your registration. If for any reason you need to request a refund, these will be allowed with written notice before September 1, minus a $50 processing fee. After September 1st, cancellations will not be refunded.

Same as Registrant

First Name *
Last Name *
Credit Card Number *
Expiration Date *
Security Code *
Company *
Address *
City *
State/Province *
Postal Code *
Country

1. NCCPA Number
2. Dietary Restrictions	Dairy Free Gluten Free Vegetarian Vegan
3. Specialty
4. Food Allergy
5. ADA Needs
6. Please check Wednesday activity functions you will attend	Welcome Reception
7. Please check Thursday activity functions you will attend	Trivia Night
8. Please check Friday activity functions you will attend	PALLA Sponsored Preceptor Workshop - Free Musical Entertainment
9. Please check the Saturday activity functions you will attend	Maryland PA Schools Alumni Networking Event - free to attendees who graduated from a Maryland PA program Challenge Bowl

For additional registrant 1
1. NCCPA Number
2. Dietary Restrictions	Dairy Free Gluten Free Vegetarian Vegan
3. Specialty
4. Food Allergy
5. ADA Needs
6. Please check Wednesday activity functions you will attend	Welcome Reception
7. Please check Thursday activity functions you will attend	Trivia Night
8. Please check Friday activity functions you will attend	PALLA Sponsored Preceptor Workshop - Free Musical Entertainment
9. Please check the Saturday activity functions you will attend	Maryland PA Schools Alumni Networking Event - free to attendees who graduated from a Maryland PA program Challenge Bowl

For additional registrant 2
1. NCCPA Number
2. Dietary Restrictions	Dairy Free Gluten Free Vegetarian Vegan
3. Specialty
4. Food Allergy
5. ADA Needs
6. Please check Wednesday activity functions you will attend	Welcome Reception
7. Please check Thursday activity functions you will attend	Trivia Night
8. Please check Friday activity functions you will attend	PALLA Sponsored Preceptor Workshop - Free Musical Entertainment
9. Please check the Saturday activity functions you will attend	Maryland PA Schools Alumni Networking Event - free to attendees who graduated from a Maryland PA program Challenge Bowl

For additional registrant 3
1. NCCPA Number
2. Dietary Restrictions	Dairy Free Gluten Free Vegetarian Vegan
3. Specialty
4. Food Allergy
5. ADA Needs
6. Please check Wednesday activity functions you will attend	Welcome Reception
7. Please check Thursday activity functions you will attend	Trivia Night
8. Please check Friday activity functions you will attend	PALLA Sponsored Preceptor Workshop - Free Musical Entertainment
9. Please check the Saturday activity functions you will attend	Maryland PA Schools Alumni Networking Event - free to attendees who graduated from a Maryland PA program Challenge Bowl

For additional registrant 4
1. NCCPA Number
2. Dietary Restrictions	Dairy Free Gluten Free Vegetarian Vegan
3. Specialty
4. Food Allergy
5. ADA Needs
6. Please check Wednesday activity functions you will attend	Welcome Reception
7. Please check Thursday activity functions you will attend	Trivia Night
8. Please check Friday activity functions you will attend	PALLA Sponsored Preceptor Workshop - Free Musical Entertainment
9. Please check the Saturday activity functions you will attend	Maryland PA Schools Alumni Networking Event - free to attendees who graduated from a Maryland PA program Challenge Bowl

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Workshop and Tickets Options

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