Tri Cities Pain Conference Registration Form 26: Submission #1577

Submission Number: 1577
Submission ID: 4575
Submission UUID: af030294-b57f-4fa1-a7a7-7e9ae6161069
Submission URI: /tripain26/form

Created: Wed, 01/14/2026 - 17:28
Completed: Wed, 01/14/2026 - 17:28
Changed: Wed, 01/14/2026 - 17:28

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

Is draft: No
Current page: Complete
First Name: Melissa
Last Name: Lockhart
Email: MELISSAK16@HOTMAIL.COM
Degree: D.C.
Specialty: Chiropractic
Clinic/Organization: Lockhart Chiropractic Inc
Conference Format: {Empty}
Address: 1410 N. Mullan Rd Suite 100 - Spokane Valley, WA 992060000
City: Spokane Valley
State: WA
Zip: 99206
Phone: 5094132482
Payment:  Card payment
Conference type: Complete Conference
Thursday: {Empty}
Friday: Virtual
Saturday: Virtual
Notes: {Empty}
anet_transaction_reference: ref1768411699
anet_payment_status: success
Ammount: 288.32
Registration code: tripain26
Title: Tri Cities Pain Conference 26
Receipt: http://www.russocme.com/webform/paid_conference_registration/submissions/4575/attachment/receipt/receipt.pdf
Payment Note: RussoCME
935 SE High St
Pullman, WA 99163
Invoice number: tripain26_1768411691
Tax: 23.32
Base amount: 265
Taxed Amount: 265
Total Days: 2
Recording Days: 0
Non Recording Days: 2
Per Day Amount: 132.5
Tax Percentage: 8.8