19th Annual Fall Scientific Meeting of the SMSNA

19th Annual Fall Scientific Meeting of the SMSNA

This meeting is being organized by the Sexual Medicine Society of North America (SMSNA) and will take place at the InterContinental Hotel New Orleans, New Orleans, LA, USA, on November 21-24, 2013.

On-line Registration Form - Step 1 of 3

Please fill out the form below to register for the 19th Annual Fall Scientific Meeting of the SMSNA.

PERSONAL DETAILS
Gender:  M  F   
First name:   *
Last name:   *
Degree:   
Organization/institute:   
Department:   
Function:   
   
Mailing address:   institute    home   *
Address:   *
   *
City:   *
State:   
Zip Code:   *
Country:   *
Phone:   -  *
Fax:   -  
E-mail:   *
  
MEETING REGISTRATION
The deadline for discounted early registration is October 25, 2013. After that date, regular registration fees will apply to online & on-site registration. Registration fees are subject to change. To lock in these rates, register now!

Evening functions (Welcome Reception, Themed Night, Banquet) are included in registration fees unless specified otherwise.

Please tick: Registration Category Registration Fee
SMSNA Member (MD/PhD) USD
SMSNA Non-Member (MD/PhD) USD
RN/NP/PA - excluding Themed Night * USD
Urology Resident * USD
Fellow (Urology or Family Practice) * USD
Other Health Professional - Member (non-industry) - excluding Themed Night USD
Other Health Professional - Non-Member (non-industry) - excluding Themed Night USD
Industry Employee (Company is a 2013 SMSNA Exhibitor)
[Note: If you are employed by industry and your company is not exhibiting at the 2013 SMSNA annual meeting but would like to register to attend this meeting, please contact us by phone (910) 667-2457 or by email info@smsna.org to confirm your registration.]
USD
Spouse/Guest Registration (Welcome Reception, Themed Night and Banquet included)
Spouse/Guest name(s):
USD 0.00
* To qualify for reduced fees, written proof of your status as a Resident/Trainee/Research-Clinical Fellow/Nurse/RN/NP/PA is required when applying (for example, a letter dated and signed by your professor/advisor or the person responsible for the PhD programme on your institution's letterhead/stationary). Upon submitting your application, please also send a scan of the supporting documentation by e-mail to info@smsna.org or fax it to: (910) 778 2586. NOTE: Your registration for a reduced fee is not considered complete without supporting documentation and will not be processed until such proof is duly received.

EVENING FUNCTIONS
One ticket to each evening function is included in attendee and spouse registration fees unless specified otherwise. Additional tickets for the evening functions can be purchased below; tickets are USD 70.00 per person per function.


# Tickets Function Fee
Welcome Reception on Thursday November 21, 2013 USD 70.00
New Orleans Themed Night on Friday November 22, 2013 USD 70.00
Official Banquet on Saturday November 23, 2013 USD 70.00
  
SPECIAL NEEDS/REMARKS
E.g. dietary, wheelchair etc.:
Alternatively, please call us on (910) 667 2457 or mail us on info@smsna.org.
  
PAYMENT METHOD
The SMSNA requires full payment for registration fees and/or optional activities by either check or credit card.