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00 Industry Representative Nurse Student Method of Payment Check payable to UTHSCSA 158289 mail to Rich Markow CTRC at UT Health 7979 Wurzbach Rd. MC 8224 San Antonio TX 78229 AMEX MasterCard Visa Discover Credit Card Number Cardholder Name Exp Date MM/YYYY CCV Signature I authorize UT Health to charge the credit card indicated on this registration form. This payment authorization is for the registration described above. Cancellation Policy. You must contact us no later than June 9 2017 to...
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