2025 Virtual Conference Registration Form
Full Name
*
First Name
Last Name
Credentials
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Current Employer/Facility Name:
*
State of Residency
*
Do you have any questions for our NICU Feeding Protocol Discussion Panel?
*Please note questions will be selected from these submissions by the planning committee to be asked during the discussion
Registration Fee:
*
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Virtual Conference Registration + Annual Membership
Conference registration and annual membership fee (choose this if you did NOT already pay the membership fee of $15)
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Current Member Conference Registration ONLY
Choose this option if you already paid the $15.00 member fee this year
$
35.00
Quantity
1
2
3
4
5
6
7
8
9
10
I agree to allow my information to be shared with vendors
*
Please Select
I agree
I do not agree
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Complete Registration
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