Midwest Dermatology Conference

Conference Registration

Midwest Dermatology Symposium Registration

Please note: Your name will not appear in the conference program if registered after July 15.

First Name*

Last Name*

Email*

Phone*

Credentials*

Specialty*

NCCPA # for PAs. (Type N/A if you are not a PA)*

Street Address*

City*

State*

Zip Code*

Dietary Requirements

Allergies

ADA special needs

Badge Information

First and Last Name for your Name Badge*

Credentials for your name badge*

Office Location / Employer*

Office City / State*

Registration Options

General Conference Registration*

**Current and Valid Student IDs must be presented. Prior approval for student attendance must be obtained before the start of the conference. On-Site student registration cannot be guaranteed if the conference space is sold out. Please send an email to Joy Logothetis, PA-C at Illinoisdermpa@gmail.com to inquire about student registration and pricing.

I have read and agree to the terms of the photographing & recording policy.*

Yes

I have read and agree to the terms of the cancellation policy.*

Yes

Total Cost