Tri Cities Pain Conference Registration Form 26: Submission #1481

Submission Number: 1481
Submission ID: 3954
Submission UUID: e6d75545-0fbb-408a-81b5-82d9c125b585
Submission URI: /tripain26/form

Created: Tue, 12/02/2025 - 00:58
Completed: Tue, 12/02/2025 - 00:59
Changed: Tue, 12/02/2025 - 01:00

Remote IP address: 192.88.134.7
Submitted by: russ4031
Language: English

Is draft: No
Current page: Complete
First Name: Grace
Last Name: McNelly
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: In Person
Saturday: Recording
Notes: {Empty}
anet_transaction_reference: ref1764637154
anet_payment_status: success
Ammount: 433.26
Registration code: tripain26
Title: Tri Cities Pain Conference 26
Receipt: http://www.russocme.com/webform/paid_conference_registration/submissions/3954/attachment/receipt/receipt.pdf
Payment Note: RussoCME
935 SE High St
Pullman, WA 99163
Invoice number: tripain26_1764637129
Tax: 18.26
Base amount: 415
Taxed Amount: 207.5
Total Days: 2
Recording Days: 1
Non Recording Days: 1
Per Day Amount: 207.5
Tax Percentage: 8.8