Tri Cities Pain Conference Registration Form 26: Submission #1544

Submission Number: 1544
Submission ID: 4471
Submission UUID: aa99417b-d6ce-45be-9b99-13d702cb04a0
Submission URI: /tripain26/form

Created: Wed, 01/07/2026 - 06:37
Completed: Wed, 01/07/2026 - 06:37
Changed: Wed, 01/07/2026 - 06:37

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

Is draft: No
Current page: Complete
First Name: christopher
Last Name: godbout
Email: cjgodbout@yahoo.com
Degree: M.D.
Specialty: Interventional Pain Management 
Clinic/Organization: MultiCare Health System 
Conference Format: {Empty}
Address: 10625 Marine View Dr SW, Seattle WA 98146-1672
City: Seattle
State: WA
Zip: 98146-1672
Phone: 9194141139
Payment:  Card payment
Conference type: Complete Conference
Thursday: {Empty}
Friday: Virtual
Saturday: Virtual
Notes: {Empty}
anet_transaction_reference: ref1767767850
anet_payment_status: pending
Ammount: 451.52
Registration code: tripain26
Title: Tri Cities Pain Conference 26
Receipt: http://www.russocme.com/webform/paid_conference_registration/submissions/4471/attachment/receipt/receipt.pdf
Payment Note: RussoCME
935 SE High St
Pullman, WA 99163
Invoice number: tripain26_1767767834
Tax: 36.52
Base amount: 415
Taxed Amount: 415
Total Days: 2
Recording Days: 0
Non Recording Days: 2
Per Day Amount: 207.5
Tax Percentage: 8.8