Attendee Registration Form

(800) 479-4936

New Email:
Director@amifasintl.org

Attendee Registration

Register for Our February 2024 Seminar

February 21-23, 2024 in Celebration, Florida

Name *

First

Last

Degree

License Number (Including State) *

(Needed to record the CECH earned)

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email Address *

Consent to use of photographic images: Registration and attendance at or participation in AMIFAS meetings, functions and other activities constitutes an agreement by the registrant to the use and distribution (both now and in the future) of the registrant or attendee’s image in photographs, videotapes, and electronic reproduction of such events and activities for marketing and professional use.

Please Initial Here:

Do you consider yourself a:

MIS beginner
MIS expert with advanced knowledge and experience
Somewhere in-between

What is your practice setting?

Hospital
Multi-Specialty Group
Private Practice
Other - please specify in field below

Practice Setting- Other

Do you request translation accommodations?

Yes, please. If yes, please indicate language in the box below.
No, thank you.

Every attempt will be made to accommodate; however, we cannot make any guarantees.

Language accommodations

Payment Information

Note: Attendee options will appear after answering the below question.
AMIFAS Member/Fellow $1895
Non-Member $1995
Student/Resident $1295

Are you a student or resident? *

Yes
No

Note: we will request verification of student or resident status.

Note: You may pay using your paypal account or with a CREDIT CARD by clicking the button below.

Total

$ 0.00

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New Email:Director@amifasintl.org