Registration – VSR 2013

 

 

Registration_Form_2013-b    ~ Please click this link and print form or

cut and paste the form below and print ~

 

Registration Form

VSR Annual Scientific Meeting

September 20 – 22, 2013 at Wintergreen, VA

 

Fees:  VSR Members $175.00  ~  Non – Members $225.00  

~ Rheumatology Fellows Free ~

 

Name: 

___________________________________________________________

 

Email Address: 

_____________________________________________________

 

Mailing Address:

_____________________________________________________

 

Hospital/Practice Location: _______________

Phone Number: ________________

Please Complete:

# attending with you ______

# attending Saturday dinner______

Special Dietary Requirements: __________________________________________

 Please select any activities you may be interested in for Saturday afternoon: [Check for activity details at the registration table]

 Golf Outing _____________           Cycling_________________

Zip Line ________________         Hiking/Other_____________

 PAYMENT:  Please make check payment to:

Virginia Society of Rheumatologists

 Registration and checks MUST BE MAILED PLEASE to the address below:

Edward Katz, MD
Secretary and Treasurer, VSR
Arthritis and Pain Center
2301 Fall Hill Ave, #103
Fredericksburg, VA 22401

 REMEMBER TO MAKE YOUR LODGING RESERVATIONS: Please call the Wintergreen Conference Center at 1-800-611-6888 to guarantee the VSR room rates by September 1. Ask for the ‘VSR’ Room Rate.   

 

 Thank you for your registration. We look forward to seeing you at the meeting. Please contact Dr. Don Kimpel and Jennifer Kaisoum with questions about the program and activities at  jmk9r@virginia.edu

 Please contact Dr. Greg Kujala and Stephanie Nelson with questions about the CME accreditation and vendor information at snelson@valleyhealthlink.com