Arkansas Urologic Society Annual Meeting
March 6-8, 2025 | Embassy Suites, Little Rock, AR
Name and credentials:
*
UAMS Medical School Alum and an AUS Member
Yes
UAMS Medical School Alum and not an AUS Member?
Yes
Year Graduated
Name of spouse/guest attending or N/A:
Clinic Name:
*
Clinic Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Reservation Purposes
The event center requests an accurate food count for each break and meal event. The AUS is charged for meals for members and guests who do not show up. If you are bringing a guest, please complete the second reservation list.
Attendee Reservations
*
Thursday Evening Opening Reception
Friday: Breakfast
Friday: Headstream Award Luncheon
Friday: Reception - Open to All Attendees
Friday Dinner Reservation - See below for cost information
Saturday Morning: Breakfast
Your Guest's Reservations
Thursday Evening Opening Reception
Friday: Breakfast
Friday: Headstream Award Luncheon
Friday: Reception
Friday Dinner Reservations - See below for cost information
Saturday Morning: Breakfast
Payment Method
Check
PayPal
Registration (Check)
AUS Physician Member - $175
UAMS Alum Non AUS Member - $175
Physician Non AUS Member - $275
Allied Health Provider - $115
Student/Resident - Free
Spouse/Guest - $50
Friday Dinner UAMS Alum - Free
Friday Dinner Non UAMS Alum - $40
Friday Dinner Guest - $40
Total Owed
Make checks payable to Arkansas Urologic Society, PO Box 55088, Little Rock, AR 72215.
Registration (credit card/paypal)
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AUS Physician Member
$
175.00
Quantity
1
2
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5
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10
UAMS Alum/Non-AUS Member
$
175.00
Quantity
1
2
3
4
5
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9
10
Item subtotal:
$
0.00
Physician Non AUS Member
$
275.00
Quantity
1
2
3
4
5
6
7
8
9
10
AUS Allied Healthcare Provider
$
115.00
Quantity
1
2
3
4
5
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10
AUS Student/Resident
$
Free
Quantity
1
2
3
4
5
6
7
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9
10
Spouse/Guest
Please register guest if they attending any meals. Friday dinner reservation is separate.
$
50.00
Quantity
1
2
3
4
5
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7
8
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10
Friday Dinner - UAMS Alum
$
Free
Quantity
1
2
3
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5
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9
10
Friday Dinner - Not a UAMS Alum
$
40.00
Quantity
1
2
3
4
5
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9
10
Friday Guest Dinner
$
40.00
Quantity
1
2
3
4
5
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9
10
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