AOS Registration Form 2022

52nd Annual Meeting Registration

American Osler Society
Date

Sunday, April 10 – Wednesday, April 13, 2022

Address

The San Luis Resort, Galveston, Texas

5222 Seawall Blvd, Galveston, TX 77551
Full Name *

First Name Middle Initial Last Name
Degree

MD DO PhD
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Phone Number *

Area Code Phone Number
Include Guest *

Yes No
Guest's Full Name *

First Name Middle Initial Last Name
Special Needs
If you have special assistance needs or dietary restrictions, describe here.
Meeting Registration April 10-13, 2022 *

Meeting Registration (includes breakfasts, breaks & lunches) $450 One Day Meeting Registration (includes breakfast, breaks & lunch) $250 Attending Virtually via Zoom $125
Which day will you be attending? *

Monday Tuesday
OPTIONAL:
Tour UTMB - Sunday, April 10, 2022, 2:30-5:30 pm (Free) Lunch for Spouse/Guest - Monday, April 11, 2022, Noon ($45) Reception, Banquet, & Presidential Address at The Grand 1894 - Monday, April 11, 2022, 5:45-9:00 pm ($95/person) Lunch for Spouse/Guest - Tuesday, April 12, 2022, Noon ($45) Reception & The Bryan Museum Tour - Tuesday, April 12, 2022, 5:30-8:30pm ($65/person)
Number of Attendees for the UTMB Tour: *
Number of Attendees for the Bryan Museum Tour: *
Payment Options* *

Pay Online Pay with a check
Make checks payable to American Osler Society in U.S. funds only.

Mail registration form and payment to:

American Osler Society, c/o Renee Ziemer

141 Co Rd 132 SE, Dover, MN 55929

Pay Online

52nd Annual Meeting Registration $ 450.00

One Day Meeting Registration $ 250.00

Attending Virtually via Zoom $ 125.00

Waive Registration Fee - For undergraduate, graduate, medical students, residents and fellows. Free

Lunch for Spouse/Guest - Monday, April 11, 2022, Noon $ 45.00

Reception, Banquet, & Presidential Address - Monday, April 11, 2022, 5:45-9:00 pm (per person) $ 95.00

Quantity

Lunch for Spouse/Guest - Tuesday, April 12, 2022, Noon $ 45.00

Reception & The Bryan Museum Tour - Tuesday, April 12, 2022, 5:30-8:30 pm (per person) $ 65.00

Quantity

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

*The conference registration fee is waived for undergraduate, graduate, medical students, residents and fellows.
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