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Test Event Form

Test Event Form

Excelen, Center for Bone and Joint Research
700 10th Avenue South
Minneapolis, MN 55415
www.excelen.org

Email: lwojcik@excelen.org
Ph. 612-336-6602
Fax 612-336-6618

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Contact Information

Enter company/organization name
Billing Address *
Billing Address
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City
State/Province
Zip/Postal

Course Information

Start time
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End time
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Facility Needs

Checkboxes

Catering

Food Requirements
Time served
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Special Requests

Equipment

Equipment
C-arm(s)
Shipping

Audio/Visual Needs

Event Registration Cost

General Admission: $21.00

Total Event Cost

Payment
Payment