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2012 Annual Conference
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2012 Annual Conference/TeamWalk

June 8-10, 2012, Hilton McLean Tysons Corner, McLean, VA

"Monumental Hopes and Dreams for a Cure"

Conference/TeamWalk Registration Form

Complete this form to register for the Annual Conference/TeamWalk. You may pay by check or credit card.

Register by May 18 for the early registration fee discount.

name attending
name as it should appear on the name tag
name attending
name as it should appear on the name tag
street address
required
city
required
state/prov
required
postal code
required
home phone (including area code)
cell phone (including area code)
e-mail
email address is not valid.

If attending only the TeamWalk on June 10, click here

at the conference I will be using
disorder
select breakout choice
special meal request
number of people attending the Friday night dinner ($45/ea - $50 after May 18th)
 
please select attendees for Friday session
number of people attending the Saturday Conference ($65/ea - $75 after May 18th))
 
please select attendees for Saturday session
number of people attending the Sunday TeamWalk ($20/ea)
 
please select attendees for Sunday TeamWalk
additional donation
 
your total

  Select a payment type to complete donation:

 
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send questions to: ac@sp-foundation.org
© Copyright 2011 Spastic Paraplegia Foundation, Inc. All Rights Reserved.