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Payment Form

Once you fill in this information, you will be routed to the secure payment form on the Texas Cancer Associates website.
Name on Credit Card
Billing Address
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State
Zip Code
Email Address
Daytime Phone
Payment Amount

Registration Fee- Physician: $60.00
Allied Health: $40.00
Industry Vendor: Diamond $1000.00 / Platinum $750 / Gold $500



If you have any difficulty with this form, please contact us at 214-739-1706.