2024 Meeting Registration Form with Payment

Registrant Name

First NameLast Name

E-mail

example@example.com

Phone Number

Format: (000) 000-0000.

Credentials

Hospital/Institution/ Organization

Professional Specialty

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Aerodigestive Society Membership

ASHA Accreditation

Dietary Restrictions or Preference

Accommodation or Special Needs Requests

Payments are processed through Stripe. You may pay with any major credit card / debit card.

Registration

In-Person Physician (Non-Member)

This is for conference full-access for in-person attendance for Non-Member Physicians.

$475.00

In-Person Physician (Member)

This is for conference full-access for in-person attendance for Member Physicians.

$375.00

In-Person Allied (Non-Member)

This is for conference full-access for in-person attendance for Non-Member Other.

$325.00

In-Person Allied (Member)

This is for conference full-access for in-person attendance for Member Other.

$250.00

In-Person Allied Student/In-Training

This is for conference full-access for in-person attendance for students and those in-training.

$225.00

Virtual Physician (Non-Member)

This is for virtual attendance for the conference for Non-Member Physicians.

$350.00

Virtual Physician (Member)

This is for virtual attendance for the conference for Member Physicians.

$250.00

Virtual Allied (Non-Member)

This is for virtual attendance for the conference for Non-Member Other.

$225.00

Virtual Allied (Member)

This is for virtual attendance for the conference for Member Other.

$150.00

Virtual Allied Student/In-Training

This is virtual attendance for students and those in-training.

$100.00

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Total

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2024 Aerodigestive Society Annual Meeting Registration

Registration