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Final Step - Registration For Advanced Medicine 2020 Conference: 3rd Ticket

Please enter the name of the 3rd ticket holder for whom you purchased an additional ticket, to insure they are registered and receive information and updates on the upcoming 2020 Advanced Medicine Conference. *Mobile number and email address will be used to validate ticket holders.

First Name

Last Name

Email (required for ticket confirmation)*

Mobile Phone (required for ticket confirmation)*

Which Of The 7 Toxicities Are You Concerned About? (Mark all that apply)

Heavy Metal Toxicity

Persistent Organic Pollutant Toxicity

Opportunistic Toxicity

Energetic Toxicity

Emotional/Psychological Toxicity

Food Toxicity

Spiritual Toxicity

Are You a Licensed Physician, Provider and/or Have A Doctorate Degree (DC, DDS, DMD, DO, DPM, MD, ND, OD, PhD, etc)?

Yes

No

Are You A Non-Physician Health Care Extender (RN, NP, PA, Homeopath, PT, Massage, Acupuncture, Health Coach, etc.)

Yes

No

We take privacy VERY seriously. You'll NEVER have to worry about your information being sold, leased or shared with any other entity. All details are kept secure and used ONLY to get you the information you requested.

Please verify your request*

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