March 31 - April 2, 2011
Kiawah Island Golf Resort
Kiawah Island, South Carolina

Attendee Registration

Fill in the information to submit your registration. If paying by credit card you will be taken to our credit card processing form when you click continue. If you experience any problems, please contact SSRF at (770) 613-0932 for assistance.

Registration Type
2011 SSRC General Lecture and Laboratory ($1500.00)
2011 SSRC Lecture Only ($1000.00)
2011 SSRC Lab and Lecture for Residents ($750.00)
2011 SSRC Lab and Lecture for Residents - Guaranteed Lab Spot ($1500.00)
2011 SSRC Lecture Only for Residents ($500.00)

Note to Residents: If you are registering for the "2011 SSRC Lab and Lecture for Residents" option, lab spots are NOT guaranteed and will be assigned on a first-come-first-serve basis. In order to secure your spot in the lab, you must register for the "2011 SSRC General Lecture and Laboratory - Guaranteed Lab Spot" option.

Lab Options
Lab stations are awarded on a first come first serve basis and preference is given to full paying attendees. Please let us know your lab preference below:

I prefer the lab on Saturday, April 2.

I would like to share a lab station with:

The Lab portion of the program takes place at the Medical University of South Carolina. This is approximately a 40 minute drive from Kiawah Island. There is potential to have a shuttle to and from the lab, but we will only provide this if a certain number of attendees choose this option. If there are not enough riders to justify getting a shuttle, we will let anyone know who has signed up that they need to find other means of transportation to and from the lab. Thank you.

I wish to ride the shuttle to and from the Lab at MUSC.

Contact Information
Attendee Name: *
Credentials (i.e. MD, FACEP): *
Name of Practice: *
Address/Suite: *
City/State/Zip: *
Phone: *
Email Address: *

Payment
  Amount Owed:
 
Paying by Credit Card
  Name on Credit Card: *
 
Paying by Check
  Please send check to:
Southern States Rhinology Foundation
c/o Atendee Registration
6134 Poplar Bluff Circle, Suite 101
Norcross, GA 30092
 
Registration Form Only (I have already paid)

Contract
  I agree to the attendee terms and conditions.
Name of Attendee: *
Date: *
Note: You must check the box and sign to complete your registration. Registrations without a signed contract are void.