Midwest Dermatology Conference

Conference Registration

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

First Name*

Last Name*

Email*

Cell Phone*

Credentials*

Specialty*

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

Street Address*

City*

State*

Zip Code*

Dietary Restrictions

ADA special needs

Badge Information

First and Last Name for your Name Badge*

Credentials for your name badge*

Office City and State*

Registration Options

General Conference Registration*

Early bird rates will apply until May 1, 2020.

**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 contact@isdpa.org 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