Convention Registration

This registration form is for doctors and medical assistants. This form is to register one individual. Please complete form separately for each additional registrant from your office.

An additional fee of $35 will be added to all registrations received after September 12, 2024. After September 12, complimentary registrations will increase to $35.

For assistance, call 888-330-5589.

First Name *

Last Name *

Credentials

Practice Name/DPM Name

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Dietary Restrictions/Special Needs

Registration Fees *

Registration Code

Name of Residency Program or School *

Late registration fee *

Late registration fee ($35)

Please help us plan for your attendance. Select the events that you will attend. *

Current Total:

$0.00

Cancellation Policy *

A refund less a $40 processing fee will be provided for cancellations received in writing by September 12, 2024. Send cancellation to inpma@indianapodiatric.org. In lieu of a refund, your paid registration fee can also be applied to a substitute attendee. No refunds will be provided after September 12.