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Conference Registration Form
Required Item (*)
First Name*
Last Name*
Company or University
E-mail*
ACGIP Membership Number
Registration Category
ACGIP Member $695
Non-Member $795
Student $310
Guest $35
CreditCard*
AMEX
Discover
VISA
MasterCard
Expiration Month and Year
--Month--
January
Febuary
March
April
May
June
July
August
September
October
November
December
--Year--
2022
2023
2024
2025
Credit Card Number
CSC