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	Date of Event: September 25th- 26th 2026 Registration Fees:Physician (per person): $300.00 if received by September 11. Physician Registration fee is $375.00 (per person) after September 11. Registered Nurses (RN), Physician Assistant (PA): (per person) $200.00. Fee after September 11: $250.00. KYCOM cancellations must in be writing by September 11 in order to provide refund. A $50.00 processing fee will be assessed on all refunds prior to September 11. Cancellation fee is $300.00 if received by September 11 $375.00 after September 11 Cancellations must in be writing by September 11 in order to provide refund. Cancellations after September 11 will not be refunded.
	Please fill out the below fields to purchase tickets for KYCOM CME & Alumni Event.
*	Full Name:
*	Registered Nurses (RN, Physicians Assistants (PA)::
*	Physician Type (MD, DO, other):
*	DO/MD ID Number:
	AOA/AMA ID Number :
*	Mailing Address:
*	City State Zip:	, ,
	KYCOM Alumni Class of:
*	Phone (Work):	( ) -
	Phone (Cell):	( ) -
*	Email Address:
*	KYCOM Primary Care CME Program:
*	Number of Tickets Needed:	cde-Numbof-14
	KYCOM Primary Care CME Program
*	Please Choose Virtual Or In Person:	Virtual In Person Section
*	Please Choose Virtual Or In Person:	Virtual In Person Section
	Founders Dinner - No Cost
	Founders Dinner - No Cost. (Number of Tickets Needed)
*	Number of Tickets Needed:	cde-Numbof-16