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Registration Fee - $375 - KCSWC Society Physician Member
Registration Fee - $475 - Non-member Physician
Registration Fee - $200 - Member NP or PA
Registration Fee - $250- Resident, Non-mem NP, PA, other

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Please return completed form by fax or mail to:
Kansas City Southwest Clinical Society
9225 Ward Parkway, Ste. 114
Kansas City, Missouri 64114
Fax (816) 523-3393