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
Postal / Zip Code
Email
*
example@example.com
Cell Number
Please enter a valid phone number.
Membership Status
*
Please Select
LSA Member
Early Career Member
Resident Member
Retired Member
Medical Student Member
Non-Member
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
Out of State Component Society Member: $125
Podium/ePoster Speaker or Jeopardy Contestant: $0
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
Support a Medical Student or Resident
Help a medical student or resident attend the LSA Annual Meeting
Yes, I want to help!
$25 - one medical student or resident
$50 - two medical students or residents
$75 - three medical students or residents
$100 - four medical students or residents
$125 - five medical students or residents
Please send my support to the following program
Please Select
Ochsner/UQ Ochsner
LSU Health New Orleans
LSU Health Shreveport
Tulane School of Medicine
All of the above
For Office Use Only
Please Select
LSU Health New Orleans
Categories:
All
All
Annual Meeting Registration Fees
LSA Kick-Off Party
Support a Medical Student/Resident to attend the LSA Annual Meeting
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next
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Annual Meeting Registration Fees
LSA Member
$
125.00
Resident Member
$
25.00
Retired Member
$
125.00
Medical Student Member
$
25.00
Out of State Component Society Member
$
125.00
Podium or ePoster Speaker/Jeopardy Contestant
$
Free
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
Support a Medical Student/Resident to attend the LSA Annual Meeting
Support a Medical Student/Resident - $25
Support one medical student or resident
$
25.00
Support Medical Student/Resident - $50
Support two medical students or residents
$
50.00
Support Medical Student/Resident - $75
Support three medical students or residents
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
Support Medical Student/Resident - $100
Support four medical students or residents
$
100.00
Support Medical Student/Resident - $125
Support five medical students or residents
$
125.00
Submit
Should be Empty: