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IAMA 19th Annual Meeting Registration

May 25th-28th, 2012; Washington, DC

Dear User:
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Are you a current paying member of Iranian-American Medical Association?



IAMA reserves the right to charge the higher non-member rate if a member name cannot be verified.
 
Registration Fee For Current Paying Members
Before 5/18 After 5/18
PRACTICING
(MD, DMD, DDS, OD, DVM, Pharm. D, DPM, DCM, DO)		 $ 250 $ 275
FELLOWS, NURSES, TECHNICIANS, OTHERS
 $ 55 $ 80
RESIDENTS
 $ 40 $ 50
STUDENTS
 $ 20 $ 30

Registration Fee For Non-Members
Before 5/18 After 5/18
PRACTICING
(MD, DMD, DDS, OD, DVM, Pharm. D, DPM, DCM, DO)		 $ 275 $ 310
FELLOWS, NURSES, TECHNICIANS, OTHERS
 $ 55 $ 80
RESIDENTS
 $ 40 $ 50
STUDENTS
 $ 20 $ 30

Personal Information
 
 
 
 
 
 
 
       
 
 
Which category best describes your current status?
PRACTICING

(MD, DMD, DDS, OD, DVM, Pharm. D, DPM, DCM, DO)




FELLOWS, NURSES, TECHNICIANS, OTHERS



RESIDENTS
STUDENTS

 
 
(Institutional ID may be required for proof of status)
 
Have you ever attended IAMA Annual Meetings in the past?


 
Can we place your name in a database for other IAMA members to contact you?


 
Emergency Contact Information - Required
 
 
 
Guest/Spouse Registration
 
REGISTRATION FOR SPOUSE:
Includes: 2 Continental breakfasts, cultural lecture and CME without Certifications
Before 5/18 After 5/18
Spouse / Guest
 		 $ 60 $ 80

Number of guest(s) attending the CME with you :: Spouse/Guest registration includes 2 Continental breakfasts, cultural lecture and CME without Certification.
 
 
Gala Dinner Registration
 
GALA DINNER - SUNDAY, MAY 27, 2012

(no ticket will be available for dinner after May 18, 2012 as the number of the seats and food are already accounted for and cannot be changed)
Members Fee
PRACTICING
(MD, DMD, DDS, OD, DVM, Pharm. D, DPM, DCM, DO) 		$ 115
FELLOWS, RESIDENTS, NURSES, TECHNICIANS, OTHERS
 $ 105
STUDENTS
 $ 95

GALA DINNER - SUNDAY, MAY 27, 2012
(no ticket will be available for dinner after May 18, 2012 as the number of the seats and food are already accounted for and cannot be changed)
Non-Members Fee
PRACTICING
(MD, DMD, DDS, OD, DVM, Pharm. D, DPM, DCM, DO)		 $ 130
FELLOWS, RESIDENTS, NURSES, TECHNICIANS, OTHERS
 $ 120
STUDENTS
 $ 105

 

By selecting the above checkbox above I confirm that I DO NOT wish to participate in CME conferences and CME Certification.
 
Washington, DC Tour - Optional
Saturday, May 26, 2012 (9am -2pm)
Do you want to take a Washington, DC tour?
If you are interested in taking the Washington, DC Tour, please select your desired number of seats. The price for the tour is not verified at this moment, but it will be announced in near future (TBA)!
 

CME Registration Fee: $
CME Guest(s) Number:  
CME Guest(s) Registration Fee: $
GALA Guest(s) Number:  
GALA Guest(s) Dinner Fee: $
Washington, DC Tour Bus Seats: 
Washington, DC Tour Fee: $

Your Total Registration Fee is: $

Cancellation Policy: Cancellations, received in writing by May 18th, 2012, will receive a refund minus $50 processing fee. No refunds will be given after this date
Please type only the BLACK letters EXACTLY AS THEY APPEAR in the box
  
 
          
 
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