Attendee Registration

Contact Information
Attendee Name value is required.
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Practice/Company
Address (Line 1)
Address (Line 2)
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Contact Phone A value is required. Contact Fax

Course Options
Please select a type of registration:
General Lecture and Laboratory* - $1550
Lecture Only - $1050
Lab and Lecture (Residents) - $800
Lecture Only (Residents) - $550

*Space limited for lab participation.

The Lab Section of the course will take place on Saturday, April 10, 2010. Please choose one of the following lab times:
I would like to sign up for the morning lab session.**
I would like to sign up for the afternoon lab session. **

I would like to have IGS at my lab station.**

** Lab session preference and IGS will be available on a first come, first serve basis. You will be notified via email of your actual lab assignment and whether or not you will have IGS at your station. IGS is NOT available at resident lab stations.

Activities

I will attend the Thursday evening cocktail party
Number Attending

Additional Information

I am paying with credit card.	The name on the credit card is
I am paying with check.	Note: Once you hit submit, you are finished with registration. Please send check to: Southern States Rhinology Foundation c/o Attendee Registration 6134 Poplar Bluff Circle, Suite 101 Norcross, GA 30092

Click here to read the Attendee Contract
I have read and agree to abide by the terms of the contract. Please make a selection.
Please type your name in the signature box A value is required.
You must check the box and sign to complete your registration. Registrations without a signed contract are null and void.

Before you submit, please verify that all information is correct! This registration will go directly to the Southern States Rhinology Foundation Executive Office. If you have any questions, you can contact the SSRF at (770) 613-0932 or at amber@theassociationcompany.com. Don't forget to make your room reservations at 1(800) 576-1570.