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 ($350)

Non-MD AHP Member ($250)

Senior Member ($200)

Spouse/Guest ($150)

Please select your non member registration type(s):

Non-Member Physician ($425)

Allied Health Professional - non MD ($225)

Resident, Fellow or Medical Student (FREE)

Spouse/Guest ($150)

Please enter the full name of your spouse/guest: *

Will you be attending the President's Dinner Cruise? * 🛈

Yes

No

Please enter the number and type of Presidential Dinner Cruise tickets you wish to purchase: *

	Adult Dinner Ticket ($125)
	Child Dinner Ticket - 12yrs and under ($75)

Are there any dietary restrictions we should be aware of (please specify)?