International Academy of Physician Associate Educators
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Surname/Last name of conference attendee (required)
First name of conference attendee (required)
Phone Number (required)
Country of Origin (required)
Please select the appropriate conference package from the list of options below (required)
Standard Package: $ 325.00 Package includes: Conference Attendance, Welcome Reception, Gala DinnerStandard Package: Special Nations Rate for Developing Countries $125.00 Package includes: Conference Attendance, Welcome Reception, Gala DinnerStudent Conference Package $ 30.00 Package includes: Conference Attendance onlySpecial Nations for Developing Countries Day Rate $ 45.00: Conference Attendance for 1 day only
If day rate was chosen, which day will you be attending?
October 4, 2018October 5, 2018October 6, 2018
Are you paying for a conference attendee or attending yourself?
I am attendingPaying for attendee
Please write your name if you are paying for a conference attendee
Email of person paying for conference attendee
If unable to process payments via PayPal due to country limitations, please email firstname.lastname@example.org
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