Bismarck - CS Vets

Contact Name *

First

Last

Title *

Business Name *

Phone *

Email *

Which Sessions Will You Attend? *

Tues., March 24 Get Your Pharmacy Back dinner ($100)
Wed., March 25 Client Service Training (Full-day program, $100)
Wed., March 25 Get Your Pharmacy Back dinner ($100)
Tues., March 24 + Wed., March 25 Get Your Pharmacy Back dinners ($200)
Tues., March 24 Get Your Pharmacy Back dinner + Wed., March 25 Client Service Training ($200)
Wed. March 25 Client Service Training + Get Your Pharmacy Back dinner ($100)

Name of Person On Credit Card *

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Last

Credit Card *

Card Number

Security Code

Name on Card

Expiration/

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Billing Phone *

Billing Email *

Total

$ 0.00

Attendee #1 Name *

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Last

Attendee #1 Title *

Attendee #1 Email *

Attendee will receive confirmation email for this event

Does Attendee #1 Have Any Special Dietary Requests?

Attendee #1 Other Dietary Request

Do you need to register a 2nd attendee? *

Yes
No

Attendee #2 Name *

First

Last

Attendee #2 Title *

Attendee #2 Email *

Attendee will receive confirmation email for this event

Does Attendee #2 Have Any Special Dietary Requests?

Attendee #2 Other Dietary Request

Do you need to register a 3rd attendee? *

Yes
No

Attendee #3 Name

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Last

Attendee #3 Title

Attendee #3 Email

Attendee will receive confirmation email for this event

Does Attendee #3 Have Any Special Dietary Requests?

Attendee #3 Other Dietary Request

Do you need to register a 4th attendee? *

Yes
No

Attendee #4 Name

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Last

Attendee #4 Title

Attendee #4 Email

Attendee will receive confirmation email for this event

Does Attendee #4 Have Any Special Dietary Requests?

Attendee #4 Other Dietary Request

Do you need to register a 5th attendee? *

Yes
No

Attendee #5 Name *

First

Last

Attendee #5 Title *

Attendee #5 Email

Attendee will receive a confirmation email for this event

Does Attendee #5 Have Any Special Dietary Requests?

Attendee #5 Other Dietary Request

Do you need to register a 6th attendee? *

Yes
No

Attendee #6 Name

First

Last

Attendee #6 Title *

Attendee #6 Email

Attendee will receive a confirmation email for this event

Does Attendee #6 Have Any Special Dietary Requests?

Attendee #6 Other Dietary Request

Do you need to register a 7th attendee? *

Yes
No

Attendee #7 Name

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Last

Attendee #7 Title *

Attendee #7 Email

Attendee will receive a confirmation email for this event

Does Attendee #7 Have Any Special Dietary Requests?

Attendee #7 Other Dietary Request

Do you need to register a 8th attendee? *

Yes
No

Attendee #8 Name

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Last

Attendee #8 Title *

Attendee #8 Email

Attendee will receive a confirmation email for this event

Does Attendee #8 Have Any Special Dietary Requests?

Attendee #8 Other Dietary Request

Do you need to register a 9th attendee? *

Yes
No

Attendee #9 Name

First

Last

Attendee #9 Title *

Attendee #9 Email

Attendee will receive a confirmation email for this event

Does Attendee #9 Have Any Special Dietary Requests?

Attendee #9 Other Dietary Request

Do you need to register a 10th attendee? *

Yes
No

Attendee #10 Name

First

Last

Attendee #10 Title *

Attendee #10 Email

Attendee will receive a confirmation email for this event

Does Attendee #10 Have Any Special Dietary Requests?

Attendee #10 Other Dietary Request

Do you need to register a 11th attendee? *

Yes
No

Attendee #11 Name

First

Last

Attendee #11 Title *

Attendee #11 Email

Attendee will receive a confirmation email for this event

Does Attendee #11 Have Any Special Dietary Requests?

Attendee #11 Other Dietary Request

Do you need to register a 12th attendee? *

Yes
No

Attendee #12 Name

First

Last

Attendee #12 Title *

Attendee #12 Email

Attendee will receive a confirmation email for this event

Does Attendee #12 Have Any Special Dietary Requests?

Attendee #12 Other Dietary Request

Do you need to register a 13th attendee? *

Yes
No

Attendee #13 Name

First

Last

Attendee #13 Title *

Attendee #13 Email

Attendee will receive a confirmation email for this event

Does Attendee #13 Have Any Special Dietary Requests?

Attendee #13 Other Dietary Request

Do you need to register a 14th attendee? *

Yes
No

Attendee #14 Name

First

Last

Attendee #14 Title *

Attendee #14 Email

Attendee will receive a confirmation email for this event

Does Attendee #14 Have Any Special Dietary Requests?

Attendee #14 Other Dietary Request

Do you need to register a 15th attendee? *

Yes
No

Attendee #15 Name

First

Last

Attendee #15 Title *

Attendee #15 Email

Attendee will receive a confirmation email for this event

Does Attendee #15 Have Any Special Dietary Requests?

Attendee #15 Other Dietary Request

Do you need to register a 16th attendee? *

Yes
No

Attendee #16 Name

First

Last

Attendee #16 Title *

Attendee #16 Email

Attendee will receive a confirmation email for this event

Does Attendee #16 Have Any Special Dietary Requests?

Attendee #16 Other Dietary Request

Do you need to register a 17th attendee? *

Yes
No

Attendee #17 Name

First

Last

Attendee #17 Title *

Attendee #17 Email

Attendee will receive a confirmation email for this event

Does Attendee #17 Have Any Special Dietary Requests?

Attendee #17 Other Dietary Request

Do you need to register a 18th attendee? *

Yes
No

Attendee #18 Name

First

Last

Attendee #18 Title *

Attendee #18 Email

Attendee will receive a confirmation email for this event

Does Attendee #18 Have Any Special Dietary Requests?

Attendee #18 Other Dietary Request

Do you need to register a 19th attendee? *

Yes
No

Attendee #19 Name

First

Last

Attendee #19 Title *

Attendee #19 Email

Attendee will receive a confirmation email for this event

Does Attendee #19 Have Any Special Dietary Requests?

Attendee #19 Other Dietary Request

Do you need to register a 20th attendee? *

Yes
No

Attendee #20 Name

First

Last

Attendee #20 Title *

Attendee #20 Email

Attendee will receive a confirmation email for this event

Does Attendee #20 Have Any Special Dietary Requests?

Attendee #20 Other Dietary Request

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What is 7+4?

Wendy is looking forward to seeing you at these seminars in Bismarck, ND.

Choose which events your team will attend.

3 Seminars to

Grow Your clinic