2025 Virtual Conference Registration

Please ensure all details in the form below are 100% accurate prior to submitting. You will receive an invoice for payment submission within two (2) business days of the form’s submission. This invoice will be sent from our payment processing provider, Stripe, and will require you to submit full payment via credit or debit card within one day of receipt. For any questions regarding payment, please contact cicerohazel@gmail.com.

Thank you!

Name

First Name

Last Name

Degree(s) held

License number, license state

Phone

Country

(###)

###

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Conference type

Please select ONE.

Confirmation

By typing your full legal name below, you confirm that all details on the form above are true and accurate. You confirm that you will submit payment to the payment processor (Stripe) on behalf of AACH within the window of time stated above the form and as written on the emailed invoice from the payment processor (Stripe) on behalf of AACH.

Notes or comments