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First Name *

Last Name *

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Email Address *

Phone Number *

Are you a Practice Owner?

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Address *

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eCheck / ACH

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Credit Card

3% Fee ($13,853.07)

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By providing your bank account information, you authorize AAOPM to debit your account for the amount shown.

eSignature (Type your full name) *

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Expiration Month *

Expiration Year *

CVV *

AAOPM Livestream Membership

− 231 + × $1,999.00

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$461,769.00

Subtotal $461,769.00

Total $461,769.00

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