Tri Cities Pain Conference Registration Form 26: Submission #1480
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Submission information
Submission Number: 1480
Submission ID: 3953
Submission UUID: 375f0181-c49d-45a3-9a99-48ff77e5f186
Submission URI: /tripain26/form
Created: Tue, 12/02/2025 - 00:55
Completed: Tue, 12/02/2025 - 00:55
Changed: Tue, 12/02/2025 - 00:56
Remote IP address: 192.88.134.7
Submitted by: russ4031
Language: English
Is draft: No
Current page: Complete
Webform: Paid/Free Conference Registration
Submitted to: Tri Cities Pain Conference Registration Form 26
| First Name | Eliza |
|---|---|
| Last Name | Grace |
| mcnellyeliza@gmail.com | |
| Degree | M.D. |
| Specialty | d |
| Clinic/Organization | |
| Conference Format | |
| Address | |
| City | |
| State | |
| Zip | |
| Phone | 3 |
| Payment | Check |
| Conference type | Complete Conference |
| Thursday | |
| Friday | Recording |
| Saturday | Recording |
| Notes | |
| anet_transaction_reference | ref1764636911 |
| anet_payment_status | success |
| Ammount | 415 |
| Registration code | tripain26 |
| Title | Tri Cities Pain Conference 26 |
| Receipt | Receipt |
| Payment Note | RussoCME 935 SE High St Pullman, WA 99163 |
| Invoice number | tripain26_1764636905 |
| Tax | 0 |
| Base amount | 415 |
| Taxed Amount | 0 |
| Total Days | 2 |
| Recording Days | 2 |
| Non Recording Days | 0 |
| Per Day Amount | 207.5 |
| Tax Percentage | 8.8 |