Conference Registration Form
May 24-27, 2024 - Hyatt Regency Denver Convention Center - Denver, CO
Early-bird registration rates are available to 11:59 pm CT on April 15th. As of April 16th, regular registration rates will apply.
Name
*
First Name
Last Name
Email
*
example@example.com
Cell Phone (in case we need to reach you)
*
-
Country Code
-
Area Code
Phone Number
Title (for name badge, if desired)
*
Please Select
None
Dr.
Dean
Ms.
Mrs.
Mr.
Preferred name to appear on name badge
Pronouns (for name badge, if desired)
*
Please Select
None - if you prefer not to list
she/her/hers
he/him/his
they/them/their
Institution/Affiliation (for name badge)
*
Emergency Contact Person and Cell Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
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The Bahamas
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Belize
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Chile
China
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Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
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Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
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Guinea
Guinea-Bissau
Guyana
Haiti
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Hong Kong
Hungary
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India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Are you registering as a Remote Registrant?
*
Yes
No
Are you a first time attendee to the NASSH conference this year?
*
Yes
No
I (attendee) plan to partake in the following food/beverage events (all are included in your registration fee):
*
Friday night reception (Friday, May 24, 2024)
Lunch (Saturday, May 25, 2024)
Lunch (Sunday, May 26, 2024)
Grad Student Social (Sunday, May 26, 2024)
Lunch (Monday, May 27, 2024)
Reception/Dinner (Monday, May 27, 2024)
Would you be interested in participating in the Take a Student to Lunch mentorship activity, as part of the lunch break on Saturday, May 25, 2024? This would be during the planned lunch for all attendees (sit with your mentee/mentor).
*
Yes, as a Mentee
Yes, as a Mentor
Not Interested
Please indicate your (attendee) meal preference for any meals/receptions:
*
No preference
Gluten Free
Gluten Free/Dairy Free
Vegetarian
Vegan
Other
Please indicate your meal preference for Monday night Dinner:
*
Salmon
Beef
Dietary restriction option
Are you registering a guest?
*
Yes (Be sure to check the "Guest" box on ticket pricing below)
No
Guests are eligible to attend the Friday night reception/opening session and the closing night reception/banquet. Guests are not eligible to attend any other food/beverage functions or presentation sessions. If you would like your guest to attend meals and sessions, they must register as an attendee.
For your each of your guests, please tell us their names and pronouns.
*
My guest(s) will attend the following food/beverage functions:
*
Reception/Opening Session on Friday Night (Friday, May 24, 2024)
Closing Reception/Dinner on Monday night (Monday, May 27, 2024)
Meal preference for my guest who is attending the Reception on Friday night (May 24, 2024) and/or the Reception/Dinner on Monday night (May 27, 2024)
*
No preference
Gluten Free
Gluten Free/Dairy Free
Vegetarian
Vegan
Other
Please indicate your guest's meal preference for Monday night Dinner:
*
Salmon
Beef
Dietary restriction option
We will be offering a printed program for attendees if registered by May, 1, 2024. Please indicate if you would like a copy of the printed program (there will be an e-version).
*
Yes, I would like a printed program
No, an electronic version is fine.
Tell us anything else that we need to know about you or your guest in order to provide an excellent experience at NASSH. Email Kim Scott, conference manager with any questions (kimscott.nassh@gmail.com)
Registration Fees: Ticket pricing includes 5% cancellation insurance.
*
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Remote Registrant
$
105.00
Student
$
288.75
Under-Employed
$
288.75
Retired
$
367.50
Regular Attendee
$
498.75
Guest
$
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
Donation to NASSH (choose quantity in increments of $25)
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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