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REGISTRATION FORM Name (as you wish to appear on your name tag) Affiliation Address CONTINUING EDUCATION OVERVIEW (Additional information available in registration packet) CE credit will be awarded

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What is name as you wish?

As you wish

Who is required to file name as you wish?

Individuals or entities requiring a specific name

How to fill out name as you wish?

Fill out the required information accurately

What is the purpose of name as you wish?

To provide a specific name for identification

What information must be reported on name as you wish?

The desired name and any supporting documentation

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