Winter 2022 Scientific Seminar Registration Information You Can Use December 8-11, 2022 The Westin, Lombard/Chicago Registration Discounts! Register by November 8th. "*" indicates required fields Membership Type* Member Member of Another State Osteopathic Association NEW Physician Member - Join Today to Receive Discounted Registration Fee Non-Member Lunch Only - Optional (guest/student) Speaker (select day of presentation) The 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 StateArizonaFloridaIdahoIndianaIowaKentuckyLouisianaMaineMichiganMinnesotaMississippiMissouriMontanaNew HampshireNew JerseyNevadaOklahomaOregonPennsylvaniaSouth CarolinaTennesseeTexasWashingtonWisconsinRegistration Type* Physician Member - $550 Retired / Life Physician Member - $325 Thursday Only Member - $220 Friday Only Member - $220 Saturday Only Member - $240 Sunday Only Member - $150 Physician Resident - $200 Osteopathic Medical Student (campus email address required) - Free (does not include lunch) Registration Type* NEW Active Member - $835 ($435 regular dues + $400 discounted registration) Thursday Only NEW Member - $505 ($435 regular dues + $100 discounted registration) Friday Only NEW Member - $535 ($435 regular dues + $100 discounted registration) Saturday Only NEW Member - $535 ($435 regular dues + $100 discounted registration) Sunday Only NEW Member - $515 ($435 regular dues + $100 discounted registration) Registration Type* Physician Non-Member - $920 Retired / Life Physician Non-Member - $695 Thursday Only Non-Member - $355 Friday Only Non-Member - $355 Saturday Only Non-Member - $375 Sunday Only Non-Member - $235 Physician Resident Non-Member - $350 Osteopathic Medical Student (campus email address required) - Free (does not include lunch) Registration Type* Thursday - $50 Friday - $50 Saturday - $50 Thursday-Friday-Saturday - $150 Registration Type* Thursday Speaker - Free Friday Speaker - Free Saturday Speaker - Free Sunday Speaker - Free Name* First Last AOA ID Number(six digit format: 000000; required for CME credit) Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* ADA Accommodations and/or Dietary Needs/Requests Primary Specialty Employment 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 I would like to pay by:* Online credit card Mailing a check to IOMS To pay by check, please mail a check to the following address and indicate in the memo or include a note "IOMS Winter Seminar". Check must be received by the IOMS no later than November 22 due to hotel commitments and planning. Call the IOMS office with questions or to register by phone. Illinois Osteopathic Medical Society 4200 Conestoga Dr Suite 102-150 Springfield, IL 62711Credit Card* DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name Cancellation/Refund Policy:Refunds minus a $75 fee through November 22. No refunds after November 23.PhoneThis field is for validation purposes and should be left unchanged.