2021 Annual Meeting Registration "*" indicates required fields HiddenAdministratorHiddenToday MM slash DD slash YYYY Registrant InformationOctober 2, 2021 Virtual Meeting Zoom PlatformName* First Last Credentials (MD, DO, etc.) Group/Practice Name* Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneEmail* Conference registration fee includes your conference tuition and e-syllabus. Registration Rates* Member Physicians - FREE - $0.00 Non-Member Physicians - $200.00 Member Nurses & Physician Assistants - FREE - $0.00 Non-Member Nurses and Physician Assistants - $150.00 Retired Physicians (Both WSNS Members and Non-Members) - $150.00 Speakers - FREE - $0.00 Residents - FREE - $0.00 Payment Type* Credit Card Cash Check Number* TOTAL Upon completing the form and clicking "submit," if any funds are due to complete the registration, you will be directed to PayPal to complete the payment for the meeting. You do not have to have a PayPal account to make a payment. CANCELLATION POLICY: We must receive written notification of your cancellation. A $50 processing fee will be deducted from the registration refund. No refunds will be issued after September 17, 2021. INQUIRIES: Contact the WSNS Office at 206-956-3624 or send emails to email@example.com.