Seattle Surgical Society 2012 Annual Meeting
Thank you for your interest in attending the Seattle Surgical Society Annual Meeting and Banquet on Friday, January 13, 2012. To register for the meeting, please fill out the information below.
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Last Name
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First Name
Guest Last Name
Guest First Name
Guest Last Name
Guest First Name
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Address 1
Address 2
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City
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State
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Postal Code
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Business Phone
Fax
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Email Address
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Include my contact information on lists distributed to other attendees.
Yes
No
REGISTRATION FEES
Meeting package (includes lunch, refreshments, reception and dinner at the Columbia Tower Club)
Note: To register your spouse or guest, please choose Dinner only option in the ALA CARTE menu.
Member Package ($250)
Nonmember Package ($275)
Resident/Fellow Package ($200)
ALA CARTE
Note: Please choose selection below if you are not attending the entire event or if you are bringing spouse or guest.
Meeting Only - Physicians/Guest ($150)
Dinner Only - Physician ($125)
Dinner Only - Spouse/guest ($125)
Guest Speaker (no charge)
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Please indicate how many will be attending each event:
Lunch
Social Hour/Jeopardy Reception
Annual Reception & Banquet
Special Requirements (Dietary restrictions, etc.)
PAYMENT OPTIONS
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Please choose your payment option below:
Check
Credit Card
If paying by check, please mail to the address below:
Seattle Surgical Society
PO Box 2459
Lynnwood, WA 98036
If paying by credit card, you will receive a link after you submit your registration that will take you to our online store.
Questions? Please call our office at 425-354-3230 for more information or send an email to seattlesurg@gmail.com.
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Indicates Response Required