2026 Long Term Care Facility Virtual Conference Participant Registration Form Participant Registration for this event "*" indicates required fields EmailThis field is for validation purposes and should be left unchanged.Name* First Last Where do you work?*What is your title?*Are you an APIC member?* Yes No Are you an APIC Chapter member?* Yes, I am a member of San Diego & Imperial County Chapter Yes, I am a member of another Chapter No Email* Enter Email Confirm Email Registration & Payment Options* Paypal/Credit Card for $25 My company or I will mail a check $25 Checks must be received 30 days from registration date. Refunds will be offered if requested before September 8, 2026 12:00am PST. No refunds will not be offered thereafter. Please mail check by September 8, 2026: SDIC Treasurer 910 Rosecrans Street, San Diego, CA 92106Product Name Price: $90.00 Total Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ