Seattle Surgical Society 2023 Annual Meeting Registration

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Thank you for your interest in attending the Seattle Surgical Society Annual Meeting and Banquet on Friday, February 10, 2023. The scientific program will be held at the Hyatt Olive 8. The banquet will be held at the Columbia Tower Club. To register for the meeting, please fill out the information below.

First Name *

Last Name *

1. Guest Name

2. Guest Name

3. Guest Name

4. Guest Name

Institution *

City *

State *

Phone *

Email Address *

Specialty *

Please email me about meeting updates

REGISTRATION FEES

Scientific Meeting Registration. Please select from the following:

Banquet Registration (please add number of guests in the box)

	Member (if not attending day meeting (125)
	Guest - MD ($125) (not attending day meeting)
	Guest - Non-MD ($100)

Please indicate how many will be attending each event:

	Lunch
	Annual Reception & Banquet

Special Requirements (Dietary restrictions, etc.)

PAYMENT OPTIONS

Please choose your payment option below: *

Check

Credit Card

Swedish Residents - send bill to Bethany Brown (choose Pay by check option on next page)

VM Residents - send bill to Dr. Chang (choose Pay by check option on next page)

UW Residents - send bill to UW Dept of Surgery (choose Pay by check option on next page)

If paying by check, please mail to the address below:

Seattle Surgical Society
PO Box 2459
Lynnwood, WA 98036

Questions? Please call our office at 206-794-9124 for more information or send an email to seattlesurg@gmail.com.