2023 Annual Meeting Attendee Registration "*" indicates required fields HiddenAdministratorHiddenToday MM slash DD slash YYYY Registrant Information19th Annual Meeting October 7, 2023 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. 2023 WSNS Membership* I would like to renew my WSNS Membership I would like to apply for WSNS Membership I have already paid my 2023 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 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 Residents - FREE - $0.00 Medical Students (MD/DO, Nursing students and Physician Assistant students) - FREE - $0.00 Affiliate Registration (PT, RN)) - $100.00 MA, CNA Registration - $50.00 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, 2023. INQUIRIES: Contact the WSNS Office at 206-956-3624 or send emails to admin@washingtonneurology.org. Δ
