Event Registration

Preceptor 2025

Description

Please refer to the program announcement on our website for more information and to obtain discount code if you are a Samford Preceptor.

Event Contact Information

Registration Form

* Required Field

Are you registering on behalf of someone?

If you are registering for someone beside yourself your name, e-mail, and phone number are required.

* I'm registering on behalf of someone. Yes No

* Your First and last name

* Your Phone

* Your E-mail

* Select Payment Type:

Discount Code _{If you were provided a discount code, please enter it here.}

* Primary E-Mail Address

* First Name of Person Attending

* Last Name of Person Attending

* Cell Phone

Date of Birth

Address Line 1

Address Line 2

City

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Enter your NABP CPE Monitor ID#()

Enter your date of birth (MM/DD)()