Open Scientific Meeting Registration 2020

30th Annual Open Scientific Meeting

August 7-8, 2020
Ft Lauderdale, FL

Registration Form
 
Last Name *
First Name *
Middle Initial *
Credentials *
MD MBBS PhD DO EdD Other

 
Institution *
Address *
City, State *
Zip/Postal Code *
Country *
E-Mail Address *
 
Telephone *
Facsimile *
Are you a member of MSIS? * YesNo
Will you attend the Happy Hour and Dinner on Friday Evening? * YesNo
Will you bring a Spouse/Partner to the Happy Hour and Dinner? * YesNo
(Please note the cost for your Spouse/Partner is $150.00)
Registration *
$500 Physician MSIS members$550 Physician non-member$200 Residents/Fellow$100 Medical Student$300 Other Healthcare Professionals$600 Industry Representatives
Dietary Restrictions *
The hotel is compliant with the American Disabilities Act. Please explain if you need assistance.
Special Needs *