IPA Event Registration


Registration LEGISLATIVE DAY SPONSORSHIP

If you are a IPA member, please put your User Name and Password here and click the Login button, if you are not a member please continue filling out the rest of the form and click the Register button at the bottom of the page.
User Name		Password


First Name		Last Name
Nickname		Practice Setting

Mailing Address		City
State/Zip		Email
Phone		Fax

LEGISLATIVE DAY SPONSORSHIP
Major Sposnor	$1,000.00
Contributor	$500.00
Donor	$250.00