Personal Information - 31st Annual MIAP Pediatric Immunization Skills Building Conference

Please note:

Payment is required by credit or debit at time of registration. We are NOT accepting checks as a form of payment.

The registration fee is $200. Exhibitor fees are: Commercial Exhibitor $3,000, Non-profit $300 or free

Your confirmation email will provide a payment receipt link which can be used for reimbursement from your organization.

A $10.00 fee will automatically be applied to all cancelled registrations.

Registrant Information

Please complete the information requested below, then click Next to continue.

* Registration Type

* First name

* Last name

* Email Address (All future conference emails will be sent to this email)

5-digit VFC Pin Number (This is required to receive Vaccine Program Storage and Handling Training credit; if this doesn't apply to you, please enter: NA)

Checkbox selection for registering on someone else's behalf

I'm registering on behalf of this person

* Mobile phone number. This is required for mobile conference app. It will also allow for text notifications for the Virtual Attendee Hub (VAH). (Please list as xxx-xxx-xxxx)

* Credentials/Degree

* Organization (Please list your full organization name, not just the acronym)

Work Address

* Address 1

Address 2

* Country/Region

USA

* City

* State/Province

* ZIP/Postal code

* Work Phone (Please list as xxx-xxx-xxxx).

How many MIAP Conferences have you attended?

This question is required.

This is my first conference
1-5 conferences
6-10 conferences
11-20 conferences
20+ conferences
I am not sure