Attendee Registration

Credit Card Billing Info
Name:
MD, DO, or CAA?	MD DO CAA
Email:
Address:
City:
State:	Oklahoma Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
Phone:
Registration Fee:	OSA Member - $250 Affiliate Non-OSA Member - $300 OSA Residents - $25 Non-OSA Residents - $50 OSA Medical Students - $25 A $50 fee will be applied to registrations made after August 7. The fee is reduced to $25 for OSA Residents and OSA Medical Students
Guest Meals ($95/person):	Your guest(s) may avail themselves of Saturday’s continental breakfast, Saturday’s box lunch and Sunday’s continental breakfast at the OSA’s negotiated cost. Sorry, individual purchases are not available
Guest Names:	Please provide names of all guests for whom you are purchasing meal passes. (Separate by comma)
Ultrasound Workshop (FREE):
Ultrasound Workshop Names:	Registration is free but limited to 50 participants.
Golf Tournament ($75/person):	Number of Golfers: