North American Burn Society 34th Annual Meeting Jackson Hole, WY January 16-23, 2016 REGISTRATION FORM I will be attending the 2016 annual NABS meeting. _______ I will not be attending the 2016 annual NABS meeting _______ Please remove my name from the NABS roster I would like help finding a roommate to share lodging expenses. All active members in attendance are expected to present a paper at the annual meeting. Emeritus and new members attending for the first time are encouraged, but not required, to present. Please register online by October 1, 2015 and submit title/abstract on line by no later than October 1, 2015. Presentation Title: Days I will be attending: Company Name: Attendee Name: Title: Mailing address: City: State: Zip: Contact Name (if different from above): Phone: Email: Enclosed are my dues and/or registration fees (US): New member application fee $35.00 _________________ Bronze level $750.00 _________________ Silver level $1000.00 _________________ Gold level $1250.00 _________________ Platinum level $1750.00 _________________ Diamond level > $2000.00 _________________ Physician Members (MD’s, DO’s) $250.00 _________________ Members (non-physicians) $175.00 _________________ Non-members $250.00 _________________ 2016 corporate sponsor level 2016 annual meeting registration fees _________________ Total enclosed Please return with check payable to: North American Burn Society (or NABS) c/o Holly Schnetzler 1290 Hammond Road Saint Paul, MN 55110-5959. Secure payment available on line with your major credit card Sponsorships include meeting registration for one attendee. Additional attendees are charged $250.00. Company Sponsorships will also receive recognition in the program and acknowledged at the NABS Annual Meeting. Lodging: Make lodging reservations directly with Alphenhof Lodge @ 307-733-3242 and request the “NABS Meeting” rate. A block of Bavarian Rooms ($149.00 plus tax) have been reserved for the meeting. Reservations must be made before October 1, 2015. For questions, contact us at www.nabsociety.org or email us at [email protected].
© Copyright 2024