Winter 2020 Scientific Seminar Registration Hot Topics in Medicine Virtually December 3-6, 2020 Membership Type*MemberMember of Another State Osteopathic AssociationNon-MemberThe CME Consortium offers the Member discount/rate to Members of other participating state osteopathic associations on the list (please select your state, which authorizes the IOMS to verify your membership status with that state osteopathic association):CME Consortium State*Select CME Consortium StateArizonaFloridaIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMichiganMinnesotaMississippiMissouriMontanaNew HampshireOklahomaOregonPennsylvaniaSouth CarolinaTennesseeTexasWashingtonWisconsinRegistration Type*Active Member - $550Retired / Life Member - $325Thursday Only Member - $220Friday Only Member - $220Saturday Only Member - $240Sunday Only Member - $150Resident - $200Osteopathic Medical Student (campus email address required) - FreeRegistration Type*Non-Member - $920Non-Member Late Registration - $970Thursday Only Non-Member - $355Friday Only Non-Member - $355Saturday Only Non-Member - $375Sunday Only Non-Member - $235Resident - $200Osteopathic Medical Student (campus email address required) - FreeName* First Last AOA ID NumberAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* ADA AccommodationsPrimary SpecialtyEmployment Type*Select Employment TypeCommunity Health CenterHospitalNon Patient CareSolo Practice / PartnershipGroup Practice, Hospital-OwnedGroup Practice, Physician-OwnedGovernment / MilitaryMedical School / UniversityOtherOther*How did you hear about this event?*Select How HeardPostcardEmail from IOMSColleague ReferralFrom AOA WebsiteFrom IOMS WebsiteOtherOther*Total $0.00 I would like to pay by:*Online credit cardMailing a check to IOMSTo pay by check, please mail to the following address and indicate clearly on the check what it is for: Illinois Osteopathic Medical Society 4200 Conestoga Dr #150 Springfield, IL 62711Credit Card* DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name
