Saturday, October 20, 2012
Cincinnati, Ohio
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Price schedule
Until August 17
August 18 - September 21
After
Physicians
$170
$220
$320
OPPA members
$145
$195
$320
Psychologists, Social Workers, Allied Health
$145
$165
$185
Residents/fellows
$65
$65
$65
( * denotes Required field)
Discount Code:
*
First Name:
*
Last Name:
*
Degree:
MD
DO
Resident
NP
PA
RN
PharmD
Other Clinician
Are you a member of OPPA?
Practice Name/Affiliation:
*
Speciality:
*
Type of Practice:
Office
Hospital
Research/Academic
Other
*
Address1:
Address2:
*
City:
*
State/Province:
Please Select
ALABAMA
ALASKA
AMERICAN SAMOA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Non-US
*
Postal Code:
*
Country:
Please Select
United States
Algeria
Argentina
Australia
Austria
Bahamas
Belgium
Bermuda
Bolivia
Botswana
Brazil
Bulgaria
Cambodia
Canada
Chile
China
Colombia
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Ecuador
Egypt
England
Finland
France
French Guyana
Germany
Greece
Guadalupe
Guatemala
Holland
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Japan
Jordan
Kenya
Korea
Lebanon
Luxembourg
Malaysia
Malta
Mexico
N. Ireland
Nepal
Netherlands
New Zealand
Norway
Pakistan
Panama
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Saudi Arabia
Scotland
Singapore
Slovakia
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Thailand
Trinidad
Tunisia
Turkey
United Arab Em.
United Kingdom
Uruguay
Venezuela
Vietnam
West Indies
Yugoslavia
Zambia
Oman
Other
*
Phone:
Fax:
*
Email Address:
you are granting us permission to
contact you via email with
updated information
Number of Years in Practice:
1-5
6-10
11-15
16-20
20+
How did you learn about this event?:
Brochure by mail
Email invitation
Ad in a journal
Online banner ad
Colleague
Other