LSA Annual Meeting Registration Form

LSA Annual Meeting Registration Form

April 14-15, 2023 | Renaissance Arts Hotel | New Orleans, LA
Name *

First Name Middle Name Last Name Suffix
Choose One *

MD DO MD, FASA DO, FASA Other
Practice/Institution *
Your Role *
City/State *

Street Address

Street Address Line 2

City State / Province
Email *
example@example.com
Cell Number
Please enter a valid phone number.
Membership Status *
Meeting Attendance
I am attending the following sessions *

ePoster Session Breakfast Annual Meeting Lunch POCUS workshop Resident Jeopardy Session
Register Me As.... *

LSA Member: $125 Resident Member: $25 Medical Student Member: $25 Retired Member: $125 Podium/ePoster Speaker: $0 (speaker only)
Social Event

Fulton Alley Lanes | Friday, April 14, 2023 | 7:00pm-10:00pm
Will you join us at Fulton Alley Lanes? The cost is $25 per person. It includes bowling, shoe rental, food, and drinks. You do not need to bowl! Just come to catch up with friends and colleagues. *

Yes! Yes, with a guest No, unable to make it
Guest Name
Registration Fees
Categories: All

All

Annual Meeting Registration Fees

LSA Kick-Off Party
prev next ( X )
Annual Meeting Registration Fees

LSA Member
$ 125.00

Resident Member
$ 25.00

Retired Member
$ 125.00

Medical Student Member
$ 25.00

Non-Member
$ 250.00

LSA Kick-Off Party

LSA Kick-Off Party includes bowling, bowling shoes, food and drink. Guests are $25 per person
$ 25.00

LSA Kick-Off Party Guest Ticket includes bowling, bowling shoes, food and drink. Guests are $25 per person
$ 25.00 Quantity

Total

$ 0.00
Should be Empty:

LSA Annual Meeting Registration Form

Meeting Attendance

Social Event