Firstname *Last Name *Email Address *Phone NumberMembershipsGold Sponsor includes 1 Life Membership Event Registration ($2000)Silver Sponsor includes 1 Life Membership ($1000)Membership Special Discount (On or Before Inauguration Event) Life Membership ($250)Yearly Membership ($250)Inauguration eventsRegistration Fees (mandatory for Physicians and Dentists) Practicing MD & DDS ($100)Non-practicing MD & DDS ($25)$150/personAdd person +Fees for additional persons:USDGrand Total=USDPayment MethodPay by OnlinePay by Cheque or CashRegisterPlease do not fill in this field.
