← Back to Conference Information 2020 Fall Conference Registration(2) Registration InformationFirst Name* Last Name* Role*MDDONPPAStudentOtherRole - Other* Affiliation* NPI Number* This is used to report CME credit hours attended.Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Registration FeesRegistration Type*Physicians - $150Non-Physicians - $125Resident Physicians - $40Coupon Total $0.00 Pay By* Credit Card Check Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name For more information, or to submit your check, contact: Liz Taylor Asst. to Executive Director North Carolina College of Emergency Physicians PO Box 1038 Wake Forest, NC 27588 events@nccep.org **Please note that no printed copies of the course syllabus will be provided. Lecture materials will be provided in an electronic format prior to the conference. PLEASE NOTE: YOU WILL NOT RECEIVE A CME CERTIFICATE UNLESS YOU RETURN A SIGNED CME REQUEST FORM INDICATING YOUR HOURS OF ATTENDANCE AND A COMPLETED POST-TEST AND ACTIVITY EVALUATION.
