VBS 2023 Annual Meeting Registration Form

2023 Annual Meeting

August 18-20, 2023 | The Kingsmill Resort
Thank you for your interest in attending our 2023 Annual Meeting! Please provide the following information to register for the event.
Registrant Name*

First NameLast Name
Registrant Email*
example@example.com
Registrant Degree*
MD, DO, NP, PA, etc.,
Registrant Phone

Area CodePhone Number
Group/Practice Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I ____________ for the VBS to include my contact information in the vendor attendee list*

give permissiondo not give permission

I will attend:*

	YES	NO
Scientific Session - Friday August 18
Welcome Reception - Friday August 18
Scientific Session - Saturday, August 19
Continental Breakfast - Saturday August 19
VBS After Dark- Saturday August 19
Keynote Speaker Dinner- Saturday August 19
Lunch- Saturday August 19

Will you be bringing any guests?*

YesNo
Hotel Reservations |The Kingsmill Resort

1010 Kingsmill Rd, Williamsburg, VA
For individuals to receive group rates, they must call Resort Reservations at 757-253-1703 or 1-800-832-5665 by (Friday, July 28, 2023) and identify themselves and their affiliation with Virginia Bariatric Society. You can also book online here.

Room block expires on July 28, 2023 but rooms may sell out before then. Book your room today!
Reminders
Cancellation policy: Full refund (less $10 admin fee) 14 days prior to the event date. 50% refund (less $10 admin fee) 5-14 days prior to the event. No refund 5 days or less prior to the meeting. Online convenience fees are non refundable.
Questions? Contact Carly Miller, VBS Executive Director, at cmiller@ramdocs.org or 804.625.3851.
Payments

Pay online now or send a check. (IMPORTANT: All resident/medical student registrations MUST select pay by check to bypass online payment system)
Payment Method

Pay online -convenience fees includedPay by check
Payment Details

Early Bird Registration ENDS on August 4th! Prices will increase on August 5th.
Check Payment Registration Categories (please select at least one category below before submitting this form):

VBS Physician Member ~ $150.00Physician Non-Member ~ $200.00VBS Integrated Health Member ~ $60.00Integrated Health Non-Member ~ $80.00Integrated Health Speaker ~ $20Physician Speaker ~ $110Welcome Reception Guest ~ $25.00 (price is per guest)VBS After Dark Guest ~ $25.00 (price is per guest)Keynote Speaker Dinner Guest ~ $30.00 (price is per guest)Resident / Medical Student ~ FREE (must select Pay by Check option to bypass online payment system)
Online Registration Categories: The number of attendees/guests must match the number of payments selected below
prevnext( X )
VBS Physician MemberA Physician who is a current member of the ASMBS Virginias Chapter
$160.00



Physician Non-MemberA Physician who is not a current member of the ASMBS Virginias Chapter
$210.00



VBS Integrated Health MemberIntegrated Health professionals in the field of metabolic and bariatric surgery. This category includes all supporting positions in bariatrics – behavioral health, pharmacology, nutrition, nursing, psychiatrists, advanced practice providers, physical therapists, bariatric coordinators, and other support staff.
$70.00



Integrated Health Non-MemberAn Integrated Health professional who is not a current member of the ASMBS Virginias Chapter.
$90.00



Integrated Health SpeakerDiscounted Speaker Fee
$30.00 Quantity



Physician Speaker Discounted Speaker Fee
$120.00 Quantity



Welcome Reception Guest
$30.00 Quantity



Keynote Speaker Dinner Guest Guests may not claim CME
$35.00 Quantity



VBS After Dark Guest
$30.00 Quantity



Total

$0.00
Paying by check?

Make check payable to VBS and mail to:

VBS
Attn: 2023 Annual Meeting Registration
2821 Emerywood Parkway, Ste. 200
Richmond, VA 23294

Resident / Medical Students must select "Pay by Check" to bypass online payment system, but are not required to send payment.

Should be Empty:

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

2023 Annual Meeting

Hotel Reservations |The Kingsmill Resort

Reminders

Payments

Payment Details