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
Email: mcnellyeliza@gmail.com
Degree: M.D.
Specialty: d
Clinic/Organization: {Empty}
Conference Format: {Empty}
Address: {Empty}
City: {Empty}
State: {Empty}
Zip: {Empty}
Phone: 3
Payment: Check
Conference type: Complete Conference
Thursday: {Empty}
Friday: Recording
Saturday: Recording
Notes: {Empty}
anet_transaction_reference: ref1764636911
anet_payment_status: success
Ammount: 415
Registration code: tripain26
Title: Tri Cities Pain Conference 26
Receipt: http://www.russocme.com/webform/paid_conference_registration/submissions/3953/attachment/receipt/receipt.pdf
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