Faculty and Resident Registration

Name
First Last
Program
Residency program or affiliated hospital
Date of arrival
Please list the date you will arrive at Big Cedar. The course begins Thursday, September 12th at 7am, Hotel accommodations will be provided for attendees arriving Wednesday, September 11th.
MM slash DD slash YYYY
Date of Departure
Please list the date you will be departing Big Cedar. The course concludes on Saturday, September 14th at 3:30pm, Hotel and dinner accommodations will be provided for attendees staying until Sunday, September 15th.
MM slash DD slash YYYY
Have you been fully vaccinated for Covid 19?
- Yes
- No
Will you be attending the Saturday night dinner?
- Yes
- No
Travel Method
Date of Birth
MM slash DD slash YYYY
Name as it appears on your ID
Preferred Airport
Frequent Flyer Number
Shirt Size
- S
- M
- L
- XL
- XXL
- XXXL
Scrub Size
- S
- M
- L
- XL
- XXL
- XXXL
Phone Number
Email
Food Allergies
Thursday Activity
Due to AdvaMed guidelines, activities will be provided by Springfield Neurological Institute.
Name of Significant Other
If accompanying you, we will be happy to help with accommodations, however, due to AdvaMed guidelines, we are only able to cover our physician attendee accommodations. Dinners will be provided by Springfield Neurological Institute.
First Last
Name of Children
If accompanying you, we will be happy to help with accommodations, however, due to AdvaMed guidelines, children may not be included in dinners or activities.
Firstname Lastname
Consent*
- I have read and agree to the policies.
Phone
This field is for validation purposes and should be left unchanged.

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