2022 Annual Meeting Attendee Registration "*" indicates required fields HiddenAdministratorHiddenToday MM slash DD slash YYYY Registrant Information18th Annual Meeting October 1, 2022 Name* First Last Credentials (MD, DO, etc.) Group/Practice Name Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneEmail Conference registration fee includes your conference tuition and e-syllabus. 2022 WSNS Membership* I would like to renew my WSNS Membership I would like to apply for WSNS Membership I have already paid my 2022 Membership dues I would not like to pay my Membership dues at this time Membership Type* Active Member - $150.00 Affiliate (PA/ARNP) Member - $100.00 Resident Member - $25.00 Emeritus - $0.00 Membership Rate* Price: 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 Affiliate Registration (Not an MD/DO) - $150.00 Residents - FREE - $0.00 Medical Students (MD/DO, Nursing students and Physician Assistant students) - FREE - $0.00 Speaker - FREE - $0.00 Board or Staff - $0.00 Payment Type* Credit Card Check 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 16, 2022. INQUIRIES: Contact the WSNS Office at 206-956-3624 or send emails to admin@washingtonneurology.org. Δ
