MsPMA Attendee Registration Form 2023

MsPMA Attendee Registration Form

April 11 - 14, 2024
Name*

First NameLast Name
Credentials
Clinic*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email Address*
example@example.com
Mobile number*
(Please enter a valid mobile number for text alert reminders)
Member?*

YesNo
Are you registering as a Resident/Student "only"? (Resident and students may attend at no charge. Must provide proof of residency and/or student ID to qualify.)*

YesNo
Select one/more of the following:*

PhysicianMedical Assistant
Number of Attendees*
Attendees will receive name badges
Please enter all required attendees and mobile numbers for badges & text alerts. *

CME AND ATTENDANCE POLICY

By registering, you agree to these terms and conditions: MsPMA physician attendees will receive a link to the MsPMA 2024 Diabetes Symposium evaluation within two weeks of the conclusion of the conference pending all conference fees being paid and attendance (on-site and virtual) verified by MsPMA. Please verify that your e-mail of record is correct. Once the on-line conference evaluation is completed by an attendee, a Certificate of Attendance based on CMEs earned will be available for printing and downloading. Attendees may earn up to 20.0 CME credits (includes 2.5 pharmacology hours)
CANCELLATION POLICY

Registration fees are refundable, minus a $75.00 cancellation fee. Refunds must be requested in writing on or before March 6th. Registration fees are not refundable after this date. Please e-mail questions to "executivedirector@mspma.net".
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