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		Checks should be made payable to NASDAT

Name:
Address:
City:
State:
Zip:
Degree: (M.D., Ph.D., R.N., Other)
Phone:
Email:
Specialty:
Payment:	Check	Credit Card, using PayPal




	Register by mail! Click here for a printable registration form need help paying by credit card? Click here (page will open in a new browser window)


	Skip ahead to Hotel Registration Information

For all inquires, contact Laura Brazil-Nichols at the Executive Director's office
phone: (281) 997-1944 e-mail: lbrazil@nasdat.org
4010 Bentley Dr., Pearland, TX 77584