Please provide the following contact information:

 Full Name
Street Address
City
State/Province
Zip/Postal Code
E-mail

    Select any of the following options that apply:

DAPA Member - Full Day - CME, Lunch, Golf $90.00 ($70.00 if paid before 10/3/08)
DAPA Member - Half Day - CME, Lunch........

$60.00 ($40.00 if paid before 10/3/08)

Non-Member - Full Day - CME, Lunch, Golf... $125.00 ($105.00 if paid before 10/3/08)*** Includes 3 months free membership
Non-Member - Half Day - CME, Lunch........... $85.00 ($65.00 if paid before 10/3/08)
Guest/Spouse - Lunch, Golf......................... $50.00
Guest/Spouse - Lunch.................................. $20.00
Student - Full Day - CME, Lunch, Golf............ $40.00
Student - Half Day - CME, Lunch.................... $20.00
Kids 13 thru 17............................................. $10.00
Kids 12 and under...................................... Free

    After submitting your form we'll email you an invoice with a link so you can pay thru PayPal.


    Revised: 09/27/08