2025 Staab Registration

Attendee Information

First Name*

Last Name*

Credentials*

AOA # (only for DO's)

EX: 012345

OK State License Number

EX: 1234; The Oklahoma State Board of Osteopathic Examiners requires the Osteopathic Founders Foundation to submit proof of your participation in any approved Proper Prescribing lectures. You must provide your Oklahoma State license number so that we may submit attendance records on your behalf.

Other Credentials, if applicable

EX: RN, APRN, NP, etc.

Specialty, if applicable

Contact Information

Home Mailing Address*

Physical Address

City*

State or Canadian Province*

Zip Code*

Cell Phone Number*

Primary Email Address*

Confirmation EmailTo be used for all program communication

Type of Email Address*

PersonalWork

Secondary Email Address (optional)

Program communication will also be sent to this email

Type of Email Address

PersonalWork

How did you hear about this year's program?*

Registration Options*

IN-PERSON ONLY, Retired Healthcare ProviderDO, MD, PA, NP, etc.

$200.00

IN-PERSON (on or before January 31, 2025)

$295.00

VIRTUAL (on or before January 31, 2025)

$400.00

Credit Card

FIRST NAME ONLY, as you would prefer it to be on your Name Badge

EX: Bill, Sue, etc.

Communication Release: By submitting this registration, you agree to receive communication from the Osteopathic Founders Foundation to the addresses provided in this form. This includes registration confirmation and symposium specific communication. Your information is confidential and will not be shared with any other entities.

Photo Release: By submitting this registration, you agree to the use and distribution of the registrant's image or voice in photographs, videos, electronic reproductions, and audiotapes of such events and activities by the Osteopathic Founders Foundation.

Refund Policy: Refunds will be issued for all cancellation requests received in writing on or before March 7, 2025; however, an administrative fee of $50.00 will be assessed.

Registration Changes: Requests for registration changes must be received in writing on or before March 27, 2025. A $25.00 administrative fee will be assessed to any registration changes.

OFF Grievance Policy: The Osteopathic Founders Foundation strives to provide medical education programs that fulfill the needs of the attendees. Any comments, questions, or complaints should be submitted in writing to Adrienne Kingsley, Education Coordinator at 8801 S Yale Ave, Suite 400, Tulsa, OK 74137 or akingsley@osteopathicfounders.org.

Please check below to agree to the policies outlined above.*

I agree

Attendee Registration

Credit Card