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45th Annual Meeting Registration
First Name:
*
Last Name:
*
Designation (MD, NP etc.)
*
Institution or Company:
*
Society Member?
*
Yes
No
Email Address:
*
Best Contact Number:
*
Please select your RMVS member registration type(s):
Active Member ($450)
Non-MD AHP Member ($300)
Senior Member ($250)
Please select your non member registration type(s):
Non-Member Physician ($525)
Allied Health Professional - non MD ($350)
Resident, Fellow or Medical Student (FREE)
Will you be attending the President's Dinner?
*
🛈
Yes
No
Please enter the number and type of Presidential Dinner tickets you wish to purchase:
*
Adult Dinner Ticket ($150)
Child Dinner Ticket - 12yrs and under ($75)
Are there any dietary restrictions we should be aware of (please specify)?