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Use upper and lower case letters exactly as you want your organization's name to appear in conference materials and signage.
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Company representative to receive all information regarding exhibits and the conference.
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Please provide your organization's website URL for inclusion in promotional materials.
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Select your form of payment from the list above. (Select all that apply.) Please have your credit card or coupon code ready to enter during checkout. If paying by check, make payable to OptumHealth Education Federal Tax ID: 30-0238641 Mail to: OptumHealth Education Attn: Bethany Severson MN101-W800 11000 Optum Circle Eden Prairie, MN 55344 (A mail service that provides tracking information is recommended.)
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Please enter your coupon code. If there is a balance due, also select the applicable form of payment (check or credit card). The discount will be applied during checkout.
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The application will not be accepted if you do not agree to the terms stated herein.