2023 Annual Meeting Attendee Registration 2023 Annual Meeting Registration HiddenToday's Date MM slash DD slash YYYY Sun Mountain Resort, Winthrop Washington June 2-4, 2023 https://www.sunmountainlodge.com/ Name* First Last Credentials (MD, DO, etc.) Preferred First Name for Badge (If different than above) Practice/Group Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands PhoneEmail* Optional – Food Preference Vegetarian Vegan Gluten free Please list any food allergies Meeting Registration WSPS Member – $415.00 Physician Non-member – $515.00 ARNP/PA Member – $265.00 ARNP/PA Non-Member – $365.00 Retired / Emeritus – $150.00 Resident – $50.00 Other OptionsThe Friday and Saturday events include 1 guest ticket. All registered attendees attend for free-it is included in your registration fee. Any additional guests over 13 years old must purchase a ticket for $100.00Will you attend the Friday night reception? (Included with registration) Yes No Friday event: how many total guests are in your party? (include any children under 13 yrs)Please enter a number from 0 to 15.Friday event: How many extra tickets would you like to purchase? QuantityAges 13 and older Price: $100.00 Quantity Will you attend the Saturday night dinner? (Included with registration) Yes No Saturday event: how many total guests are in your party? (include any children under 13 yrs)Please enter a number from 0 to 15.Saturday event: How many extra tickets would you like to purchase? QuantityAges 13 and older Price: $100.00 Quantity Optional – Pay My 2023 WSPS Membership DuesWSPS Dues for 2023: $300 Yes, I would like to pay my dues Optional – Pay My 2023 WSPS Membership Dues Price: Information Sharing Permission* I will allow WSPS to share my name and city of practice with exhibitors. I will not allow WSPS to share my name and city of practice with exhibitors. PaymentCoupon TOTAL $0.00 Payment Type Credit Card Check Check Number* CREDIT CARD American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name CANCELLATION POLICY: We must receive written notification of your cancellation. A $75 processing fee will be deducted from the registration refund. No refunds after June 1, 2023. INQUIRIES Contact the WSPS Office at 206-956-3642 or email admin@wasocietyofplasticsurgeons.org. Δ
