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Meeting Registration Form

Please enter the attendee information in the required fields below.

Email Address *

First Name *

Middle Initial

Last Name *

Suffix

Degree

Country *

Street Address *

City *

State / Province *

Zip / Postal Code *

Phone *

Profession *

Subprofession *

Year of Graduation *

Specialty *

Subspecialty *

Registration Fee

Categories not listed (including corporate attendees) may register by phone at 1-877-307-5225 ext. 219 or ext. 476 (Mon-Fri 9-5 ET).

Have a priority code? Enter it on the next page and tap apply to see the discount reflected in order total. No refunds can be given post-purchase for priority codes, so please have it ready at time of registration.

Select your educational program: *

Select your registration category: *

Early Bird Registration - Administrator - $850 Expired June 30, 2018
Preregistration - Administrator - $950 Expired September 30, 2018
Administrator Registration - $1,050
Early Bird Registration - Nurse/Allied Health Professional - $850 Expired June 30, 2018
Preregistration - Nurse/Allied Health Professional - $950 Expired September 30, 2018
Nurse/Allied Health Professional Registration - $1,050
Early Bird Registration - Comprehensive Ophthalmologist - $1,500 Expired June 30, 2018
Preregistration - Comprehensive Ophthalmologist - $1,600 Expired September 30, 2018
Physician Registration - $1700
Resident/Student Comprehensive Program - $515
Early Bird Registration - Retina Specialist - $1,500 Expired June 30, 2018
Preregistration - Retina Specialist - $1,600 Expired September 30, 2018
Physician Registration - $1700
Resident/Student Retina Program - $515

*Residents/students must submit a letter of verification at time of registration by faxing it to 856-251-0278.

Attendees and guests are invited to take a journey through the legends and history of Hawaii complete with stories, drum beats, folk music, hula dancing and fire performers. The family-friendly luau will be held Thursday, January 24, 2019, from 6:30 pm – 8:00 pm at the Hilton Waikoloa Village.

Ticket prices include entertainment, Polynesian dinner/dessert buffets, open bar (including beer, wine and mai tais) and non-alcoholic drinks. Once onsite at the Hilton Waikoloa Village, you can pick up your reserved luau tickets at the Hawaiian Eye and Retina Registration Desk located in the meeting area foyer.

Luau Cancellation: Requests for refunds must be submitted in writing to registration@contactAMS.com prior to January 21, 2019 and a $25 fee will apply per person for ages 13+. Requests received after these dates will be ineligible for refunds.

Ages 13+ – $124.81 each (Hawaii Excise Tax will be applied on next page)

Ages 5-12 – $51.84 each (Hawaii Excise Tax will be applied on next page)

Ages 1-4 – FREE, but please reserve a chair if needed

How did you hear about the meeting? (select all that apply)

Brochure

Letter

Postcard

Healio

Internet Search

Word of Mouth/Colleague

Phone

Other

By processing this registration, I understand and agree to the following:

I have read and accepted the Terms & Conditions outlined in the Privacy Policy as it pertains to the information we collect for registration, information collected while using our site, and the usage of cookies on this website.

I agree the Wyanoke Group may keep me informed with emails containing meeting updates and related information.

Requests for refunds must be submitted in writing to registration@contactAMS.com. For meeting registration, submit prior to January 3, 2019 and there will be a $200 service charge retained for physician refund requests and $100 for all other registration categories. For the luau, submit prior to January 21, 2019 and a $25 fee will apply per person for ages 13+. Requests received after these dates will be ineligible for refunds.

MARK YOUR CALENDAR

JUNE

30

Early-bird discount expires
SEPT

30

Pre-registration discount expires
DEC

28

Hotel reservation deadline
JAN

14

Online registration closes

QUICK LINKS
Registration
Group Registration
Claim Credit
Meeting App
Meeting Coverage
Exhibits & Sponsorships
Privacy Policy
Manage Email Preferences

CONTACT US

Toll-free: 800-257-8290 x219 or x476
Local: 856-848-1712 x219 or x476
International: +(1) 856-848-1712 x219 or x476
Fax: 856-251-0278

Email Registration

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AMS Meeting Registration | 6900 Grove Road | Thorofare | NJ | 08086-9447 | USA

Meeting Registration Form

Registration Fee

MARK YOUR CALENDAR

Early-bird discount expires

Pre-registration discount expires

Hotel reservation deadline

Online registration closes

QUICK LINKS

CONTACT US

GET IN THE KNOW!

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