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Group Participation Registration
*: Required
Group Information
Group Name Name of Practice*:  
Group Full Name:
Category: Category:  Pediatric Group:Yes
Medical Director Information Last Name*:  
First Name*:  
Physician and practice locations Physicians*:  
Individual practice locations:
(This is only for groups that wish to have peer reviewer data separated by locations
Address Line 1*:  
Line 2:
City*:  
State\Providence*:
Zip Code*:
Country:  
Your Profile
User Name:
Last Name:  
First Name:  
Display Name:  
E-mail*:  
Confirm E-mail*:
Phone*:  
Fax:

After successful registration, you should receive confirmation E-mails.
Please login with the information to edit and
complete the registration process. If you have experienced problems,
please contact ACR RADPEER Program (fjackson@acr.org).