Edit Attendee

Registration Type

Attendee *

Name of Residency Program *

Year of Completion *

Exhibitor *

Will items be sold/promoted at your booth? *

Yes

No

Please describe/list items to be promoted and/or sold. *

Summarizing is acceptable for written materials. For example: 'Books fitting the mission of AMEN published by Pacific Press' or Glad Tidings Publishers would be sufficient for those organizations.

Addons

Electricity for Exhibit Space - Free for regular use

Child Care

Child Care ($10)

Childcare Friday afternoon during the seminars (2-5:30pm)

Registration Deposit Method *

Credit Card

Check

Your refundable $100 deposit may be made by mailing a check to
AMEN
PO Box 398
Weed, CA 96094-0398
Please write STUDENT ATTENDEE DEPOSIT on the memo line of the check so your check will not be cashed. Checks will be destroyed and PayPal deposits refunded by November 13, 2020 UNLESS you do not show up or if you cancel AFTER October 18, 2020.

Medical/dental school *

Area of Study *

Graduation Year *

Arrival Date *

Departure Date *

Roommate Type * Roommate Type

Gender *

I confirm that my spouse and I are already married *

Yes

1. Please state your reasons for why you need a subsidy to attend the AMEN conference. Please include your reasons for wanting to attend the conference, your professional background, and plans for how you hope to further the mission of AMEN. *

2. Please attach a letter of good standing from your church pastor (letter must be on church letterhead) *

Maximum upload size: 268.44MB

3. Please note, we do not pay for airfare to attend the conference. Also, the subsidy granted may only be for a portion of the total conference cost, and not the full amount. *

I accept the conditions

Total

Discount Code

First Name *

Last Name *

Degree

City *

State * State

Select other for international

Cell Phone *

Email *

Specialty

Age *

Continuing Education

CME Credits - $45

CDE Credits - $45

Dental License #

OE Tracker #

Organization *

Mission *

Goal *

Is this your first AMEN conference? *

Yes

No

I am planning on attending the business meeting on Thursday 10/29 at 5:30pm. *

Yes

No