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RSVP

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

Please enter your contact information below to register for the 2018 AUPN New Chair Luncheon.

Name (first, last): *
Institution: *
City: *
State: *
Email *
cc Email
Please select if you will be participating as a New Chair or a Senior Mentor Chair *

To help manage food waste, AUPN asks that you please indicate if you require lunch during this session. Please note, that if at any time your lunch preference changes, please email neuro@aupn.org. Thank you.

Do you require a lunch during this session? *
Please list and dietary restrictions or put N/A for none *

Thank you!






Your form submission WILL be encrypted using SSL to ensure your privacy.


 

 

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