UTHSC - Custom Order Form First Name*Last Name*Email Address*Please be sure to enter your NON residency email address. If you have ever given us a different email address, please type that below.We want to limit the number of emails you get. Two different email addresses could mean that you'll get too many emails from us. Some for members and some for non-members. Please help us avoid that by typing in any alternate email address that you may have so that we can remove your other email address(es) from our database.This field is hidden when viewing the formDate MM slash DD slash YYYY This field is hidden when viewing the formSubject*Terms & Conditions* I agree with the statement below regarding PBR's Terms and Conditions.I have been provided with PBR's Terms & Conditions and I agree with them.Consent to receive emails* I agree to the statement below. It's okay for PBR to email me.I agree to allow Pediatrics Board Review Inc. to email me regarding my orders, content updates and other miscellaneous updates. I understand that Pediatrics Board Review Inc. does not sell or otherwise share subscribers' contact information with any affiliate companies.Security statement* I agree to the statement below regarding security measures to prevent internet theft.Pediatrics Board Review Inc. resources are meant for individual use and are not to be shared. This includes, but is not limited to, the sharing of usernames, passwords, downloadable resources, streaming resources, and the sharing of test-taking strategies taught through through the various test-taking strategy courses. Pediatrics Board Review Inc. uses security measures to track usage and to detect account sharing in order to prevent theft and fraud. If such activity is detected, related accounts will be cancelled, no refunds will be issued and violators will be prosecuted to the fullest extent of the law.PGY Level*PGY-4PGY-3PGY-2PGY-1OtherWhich of the following describes you best?*Categorical pediatricsInternal Medicine/PediatricsOtherWhen will you take your ABP Initial Certification Exam?*The exam is usually in October of the year that you graduate from pediatric residency. October 2021 October 2022 October 2023 October 2024 Other Which discounted bundle would you like to sign up for?* NO BRAINER (Most popular and most appropriate for this exam.) ALL ACCESS PASS (Very popular and appropriate for this exam.) PBR FOR LIFE (Not very popular, and least appropriate for this exam.) Good job! You chose the No Brainer.*Please accept the statement below. I understand that if 6 or more residents sign up, my total after discounts and the $50 referral fee will be $895. If less than 6 people sign up, my total will be $945. Good job! You chose the All Access Pass.*Please accept the statement below. I understand that if 6 or more residents sign up, my total after discounts and the $50 referral fee will be $797. If less than 6 people sign up, my total will be $847. Good job! You chose the PBR For Life.*Please accept the statement below. I understand that if 6 or more residents sign up, my total after discounts and the $50 referral fee will be $395. If less than 6 people sign up, my total will be 445. Regarding the referral fee timeline...*Please accept the statement below. I understand that I'll get an additional $50 in the form of a partial refund after the 30-day refund window closes. Credit Card Authorization* I agree to the statement below.I agree to allow Pediatrics Board Review Inc. to charge the credit card submitted on the previous page the amount shown as the total amount above, or less if additional discounts apply.If there's anything else you'd like for us to know, please type it in the box below.For example, if you put the wrong email address on the previous page, you can let us know that here. If you have a question about something above and would like to give us a "yes/no" type of question that we can answer before processing your order, then please type that question/clarification below Δ