OEIS | 10th Annual Meeting (2023) - Resident/Student Registration

ADDITIONAL INSTRUCTIONS FOR RESIDENTS / FELLOWS / STUDENTS

Residents, fellows, and students can receive FREE admission. Please submit a letter of recommendation from your program director to: julie@oeisregistry.com within 15 days of registration.

NOTE: Each resident, fellow, or student in your party must submit this form individually.

IMPORTANT: We recommend that you register on a computer or laptop rather than registering on a mobile device. Some have reported registration difficulties on mobile devices. For registration assistance or to report a technical issue, please contact Technical Support. Thank you!

"*" indicates required fields

REGISTER AS A RESIDENT / FELLOW / STUDENT

May we share basic information about you with our industry colleagues?*

YES

NO

Please Opt-in or Opt-out to have your contact information shared with our OEIS industry colleagues. If opting IN, the only information provided to industry colleagues will be: Attendee's First Name, Last Name, City, State, and Country.

Are you a Resident/Fellow/Student?*

Prefix:

Name:*

First Last

Name as it should appear on badge:*

Specialty:*

What is your specialty?*

Title:

Email:*

Enter Email Confirm Email

Practice Name:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:*

(x1) Attendee Registration*

Price:

Total:

Billing Address:*

Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card Information:*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Unique ID

Comments

This field is for validation purposes and should be left unchanged.