2024 FSR Meeting Registration: Non Member & Practice Manager

FSR 2024 Annual Meeting Registration

Please Note: You will need to allow pop-ups and redirects when using this form.
Industry Representatives: Please note that this form is not intended for registration purposes. We offer a variety of sponsorship opportunities tailored for industry representatives. Please contact Joe via email for more details and to discuss how you can be involved.
Physician Non-MemberPharmDFellow in TrainingPractice ManagerAssociate Health Professional (PA, APRN)ResidentMedical StudentIndustry Rep - Please do not complete this form - contact Joe@fsrmd.org to register!
Attendee Name*

First NameMiddle NameLast NameDesignation (MD, DO, APRN, PA-C, etc. )
Organization/Company/Hospital*
Medical School*
Practice Name:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Practice Phone Number*

Area CodePhone Number
Fellowship Institution*
Expected Completion Date*

MonthDayYear
Date
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number (This is an optional field. By providing your mobile number you are opting into receiving text messages from FSR. This information will not be shared or made public. You may opt out at any time.)

Area CodePhone Number
Email*
example@example.com
Medical License #*
NPI #
Registration Types and Rates

FSR Members: A member registration link was emailed to you. If you are a member and did not receive the registration link please email FSR.

$425

Fellow in Training/Resident Physician/Medical Student $0

Non Member Physician/PharmD/Associate Health Professional

$700

Practice Managers

$250
Non Member Physician/PharmD/Associate Health Professional: $700Fellow in Training: $0Practice Manager: $250Resident: $0Medical Student: 0
Your registration is not finalized until you complete the next step and submit payment. Click the 'Continue' Button below to proceed to Step 2 (Payment).

Please Note: You may need to allow pop-ups and redirects to Continue to Step 2: Payment Page.

*Fellow in Training do not need to complete Step 2 (Payment).

If you do not receive the confirmation message within a few minutes of registering, please check your spam/junk email folder.

Cancellation Policy:

Event registration cancellations received by email before midnight on Wednesday, June 12, 100% refund.

Event registration cancellations received by email before midnight on Wednesday, June 26, 50% refund.

Event registration cancellations received by email after midnight on Monday, July 8, no refund

Please refer to your hotel confirmation for the rooms reservation cancellation policy.
Should be Empty:

FSR 2024 Annual Meeting Registration