Southwest Nephrology Conference Registration
Please complete your registration by filling in the form below including payment.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Certification & Credentials
*
Please Select
APN- Advanced Practice
APRN- Advanced Practice Registered Nurse
CCHT- Certified Clinical Hemodialysis Technician
CMA- Certified Medical Assistant
CPT- Certified Phlebotomy Technician
CRNA- Certified Registered Nurse Anesthetist
DDS- Doctor of Dental Surgery
DMD- Doctor of Dental Medicine
DO- Doctor of Osteopathic Medicine
LCSW- Licensed Clinical Social Worker
LPN- Licensed Practical Nurse
MD- Doctor of Medicine
MSW- Master of Social Work
MT- Medical Technologist
ND- Doctor of Naturopathic Medicine
NP- Nurse Practitioner
PA-C- Physician Assistant
PharmD- Doctor of Pharmacy
PhD- Doctor of Philosophy
RPh- Registered Pharmacist
RD- Registered Dietitian/Nutritionist
RN- Registered Nurse
Other
Specialty
*
Please Select
Anesthesiology
Emergency Medicine
Cardiology
Cardiothoracic Radiology- Diagnostic
Critical Care
Family Medicine/Practice
General Practice
Geriatric Medicine/Practice
Infectious Disease
Internal Medicine
Nephrology
Oncology
Pathology
Pediatrics
Primary Care Practice
Radiology- Diagnostic
Urology
Transplant Cardiology
Transplant Nephrology
Vascular & Interventional Radiology
Other
Select the days you will be attending SWNC
*
BOTH Thursday & Friday
ONLY Thursday
ONLY Friday
Lunch meal selection
*
Please Select
Main Entree
Vegetarian Entree
Vegan Entree
N/A- Exhibitor Boxed Lunch
N/A- Not Eating at Conference
I understand and acknowledge that in-person attendance at the Southwest Nephrology Conference may potentially expose me to contact with one or more persons with, and/or exposed to the COVID-19 virus. I understand that, as a result, my in-person attendance at this event may expose me to a risk of exposure to or infection with the COVID-19 virus. I knowingly assume this risk. I understand thatvaccination with an approved COVID-19 vaccination is encouraged and that I amrequired to and agree to follow all required safety measures put in place bythe Conference.
*
I have read and understand the above acknowledgement.
Privacy Policy: In the course of operating this event and in an effort to deliver the highest quality service possible, your contact information, including name and email address may be shared with commercial supporters.
*
I have read and understand the above acknowledgement.
Registration Type
*
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Physician
MD, DO
$
333.00
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Item subtotal:
$
0.00
Advanced Practice
NP, PA, PA-C
$
166.00
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Fellow in Training
Must be currently enrolled in fellowship.
$
166.00
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Nurse
$
166.00
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Dietician
$
166.00
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Pharmacist/Technician
$
166.00
Days Attending
Thursday & Friday, March 20-21
Social Worker
$
166.00
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Full-time Student
Must have a current valid student ID to show. Registration type does not provide CME/CEUs.
$
66.00
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Point of Care Ultrasound Immersion Course
$
1,250.00
Planning Committee Member
Must be part of official planning committee for SWNC 2025
$
Free
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Sponsorship Package Complimentary Attendee
Must be included in the sponsorship package your company has purchased and must be designated on list submitted.
$
Free
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Exhibitor for Sponsorship Booth
Must have already purchased sponsorship booth and be designated on list submitted by company. Registration type does not provide CME/CEUs.
$
Free
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Non-CME/Added Exhibitor Pass
Registration type does not provide CME/CEUs.
$
150.00
Days Attending
Thursday & Friday, March 20-21
Thursday, March 20, ONLY
Friday, March 21, ONLY
Credit Card
First Name
Last Name
Credit Card Number
Security Code
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Expiration Month
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2025
2026
2027
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2031
2032
2033
Expiration Year
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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