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Lyon Scientific Registration Form
Email
Last Name
M.D
D.O
Dr.
First Name
Companion Name(s)
Companion Email(s)
Badge Name(s)
City, State/Province
Zip/Postal Code
Country
Phone (home)
Phone (work)
Phone (mobile)
Scientific Registration (before March 1, 2023): $2,895.00
Scientific Registration (After March 1, 2023): $2,995.00
Plus 5 SAM (Self Assessment Modules) Credits: $250.00
Social Registration (companion(s)): $575.00
Total
There will be no refunds after December 19, 2022. Before then, there will be a cancellation fee of $350.00
Payment Method:
Visa
American Express
Master Card
Cheque
Card / Cheque #
Exp Date
Security Code
Total Enclosed $
Authorized Signature
There will be no refunds after December 19, 2022. Before then, there will be a cancellation fee of $350.00
Submit
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