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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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No Processing Fee

Credit Card

3% Fee ($89.97)

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Name on Account *

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

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Card Number *

Expiration Month *

Expiration Year *

CVV *

AAOPM Livestream Plus Membership

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$2,999.00

Subtotal $2,999.00

Total $2,999.00

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