VPMA 2022 Summer Meeting - DPM Registration

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Phone:
• * Emergency Contact Name and Phone:

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  VPMA Member	$399.00
  APMA Member (any other state)	$479.00
  Non-member	$749.00
  VPMA Life Member	No Charge
  APMA LIfe Member (any other state)	$179.00
  Resident or Student	No Charge
  Federal Service Member (APMA member of Federal Service Component)	$179.00
  Guest/Spouse (Non-DPM)	$129.00

Additional Attendees Information

You may add a maximum of 1