AZUS meeting reg form 2023

Arizona Urological Society

Annual Meeting Registration
August 4-6, 2023

EL CONQUISTADOR TUCSON HILTON RESORT

Please complete this registration form and the payment page. Your registration will be acknowledged by email. THANK YOU!

Please select your category: *

Registration includes:

CME Credits, Friday Night Reception, Cont.Breakfast, and Refreshment Breaks / Saturday Evening Reception / Business Meeting, Sessions, Exhibits. Spouse/guest no charge for paid-up members.

Full Name *

Addendum

Badge First Name *

Organization / Company Name

Email Address *

Office Phone *

Mobile Phone

Resident Graduation Year *

Address *

City *

State *

Zip *

I am bringing a spouse/guest (no extra charge) *

Yes

No

Spouse / Guest Name

I am bringing children (number) *

Will you be staying at the group hotel? *

Yes

No

Days / Events Attending *

Friday Evening Welcome Reception

Saturday Meeting Sessions

Saturday Evening Dinner/Reception

Sunday Meeting Sessions

Comments:

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Admin Code

Member current on dues, $0	Member unpaid dues, $200	Residents, $0
Corresponding Member, $100	Phys. Non-Members, $400	AZ Allied Health Pros, $100