Name* Hospital or Organization* Title* Department* Email* Phone* Address Address 2 City State/Province Zip/Postal Code Country Dinner Reception Yes, I am planning to attend the dinner reception on November 3, 2024 at 6:30 pmNo, I am not planning to attend the dinner reception Please List Any Dietary Needs or Restrictions (such as Vegetarian or Allergies) AIMS 3 Training Sessions Yes, I would like a one hour AIMS 3 training session after the general session on Wednesday, November 6, 2024? Training is $100/per person, per session Note: A box lunch is included with the training. Payment I Will Call With A Credit Card (preferred)PO Will Be Issued (preferred)Check Will Be Mailed I am interested in being a speaker at this year's conference (All speakers will receive a 50% discount off their registration price) Receive a 25% discount for registrations paid by June 30, 2024 Receive a 25% discount for groups of 6 or more NOTE: Only one discount per registration may be used. Discounts may not be combined. Cancellation Policy I agree to the terms of this cancellation policy* After submitting, you should receive an email confirmation. If you do not receive this confirmation, please have your IT department check for it on your spam filter. Δ
