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Pediatric Solutions Workshop Registration
How did you hear about the workshops?
Attendee(s)
Registration price (as indicated in the dropdown menu) is per person/workshop. PCC will invoice you.
NameWorkshop
Name
Workshop
Name
Workshop
Name
Workshop
Name
Workshop
Are there specific issues you would like to see addressed in the workshop you've chosen?
Practice Information
Contact information is required for invoicing.
Practice NameContact Name
Address
City State Zip
Phone Number
Email Address
Fax
Promotional Code
Please enter your promotional code if applicable
Invite a Friend and Save $25
Invite a friend to join you at the workshop. If you both attend, you and your friend will receive a $25 discount on your registration. Just give us the friend's contact information below, and the discount will be reflected on your invoice.
YES! I'd like to invite a friend.Friend's name
Address
City State Zip
Phone Number
Email Address
