AZUS meeting reg form 2019

Arizona Urological Society

Annual Meeting Registration | August 2-4, 2019

The Scottsdale Resort at McCormick Ranch
Scottsdale, AZ

Please complete this registration form and the payment page. Your registration will be acknowledged by email. THANK YOU! (REGISTER BEFORE JULY 10 TO AVOID A LATE CHARGE)

Please select your category: *

Registration includes:

CME Credits, Friday Night Reception, Breakfasts, Lunch and Refreshment Breaks, Saturday Afternoon Pool Party and Evening Dinner (families welcome), Business Meeting, Sessions, Legislative Updates, and Spouse attendance.

Full Name *

Addendum

Badge First Name *

Organization / Company

Email Address *

Office / Mobile Phone *

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 hotel? *

Yes

No

Days / Events Attending *

Friday Evening Welcome Reception

Saturday Meeting Sessions

Saturday Afternoon Pool Party

Saturday Evening Dinner/Reception - AZUS BBQ Bowl

Sunday Meeting Sessions

Comments:

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Admin Code

Member current on dues, $0	Member unpaid dues, $200	Residents, $0
Non-Members, $400	Health Professionals, $0