2022 January Alumni Event

Kindly complete this form today to help us make the
Conference Amazing for You!

First Name *

Last Name *

Email Address *

Mobile Number *

Are you bringing your spouse to attend the Conference? The spouse fee is $650 includes their attendance for Friday and Saturday. *

Yes

My spouse's name is:

Practice Address - Street *

Practice Address - City and State *

Zip Code *

We have secured a block of sleeping rooms at The Saguaro for those who choose to stay on site. It's a beautiful, boutique hotel located in the Old Town Scottsdale.

Please book your rooms online here:

Saguaro Hotel Sleeping Room Block

Please check all that apply to your registration. *

Doctor Registration $1525

Additional attendee or Spouse Registration $650

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