Grand Rounds Charlotte/Kannapolis How many people are you registering? * 1 2 3 4 Fill in your registration information on this page. You will be able to enter the registration information for additional people after you complete this page and click "Continue". Account Please enter a Username to create an account. If you already have an account please login before completing this form. Username * Check Availability Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores. Your Registration Info First Name * Last Name * Email Address * I agree to receive text messages from NCIMS Yes Grand Rounds Charlotte Ticket Event Registration * Member - $ 0.00 Non-Member - $ 99.00 Grand Rounds Add Ons Lunch Walk & Tour Standard Process Lab - $ 0.00 UNC Nutrition Research Institute Tour 5pm - $ 0.00 Chophouse 101 Group Dinner 6pm (on your own w new friends!) - $ 0.00 Total for this participant Credit Card Card Type - select - Visa MasterCard Amex Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Billing Name and Address Billing First Name * Billing Middle Name Billing Last Name * Street Address * City * Country * - select - United States State/Province * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Review
