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Annual Convention SIGN UP
Event Title
Event Date
Event Time
Annual Convention 2017
4 November 2017
07:00 PM Onwards
Registration
  Member     Non Member or Guest
First Name*
Last Name*
Address
Email
Phone No.*
  No Of Tickets
IMASC Member   ($75 per person  Including Dinner and Drinks)    
Non IMASC Member/Guest   ($100 per person  Including Dinner and Drinks)    
Payment*
Payment Mode* Check Online (Paypal)

Note : -

For Check : Mail check to IMASC at P.O.Box 3006, Cerritos, CA 90703


KARTIK THAKER M.D.
Imascpresident2017@gmail.com
562-505-9401
 


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