Name Hospital or Organization Title Department Email Phone Dietary Needs/Restrictions Vegetarian? YesNo Vegan? YesNo Are you planning to participate in the group activity on Sunday, October 16? YesNo Symposium: $625/per person Payment Options Check FollowingPO PO Number Cancellations prior to September 14, 2022 receive 100% refund; cancellations after September 14, 2022 forfeit the full symposium fee of $625. I agree to the terms of this cancellation policy. Please contact Terri Garrett at Phoenix Data Systems if paying with Visa or MasterCard.