NOTE: Once you have successfully submitted your annual practice report the form will disappear and you should receive a message on the screen that says that the form has been submitted. If the form does not disappear after you click on the “Submit” button, please review your form to see if any fields have been left blank. The form will only be accepted if all of the fields have been filled. If you run into technical difficulties, please contact Jen at email@example.com. If you wish to inquire about your affiliation or make changes after the form has already been submitted, please contact Leslie at firstname.lastname@example.org.
$100 Affiliation Fee
Please select the “Add to Cart” button below and you will be led through the online purchase process.