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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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Please provide your organization's website URL for inclusion in promotional materials, if applicable.
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Please select the applicable form(s) of payment. Check payment information: 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
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The application will not be accepted if you do not agree to the terms stated herein.