Online Registration Arizona United Rheumatology Alliance 2020 Annual Meeting December 4 – 6, 2020 Enchantment Resort Hotel & Spa Sedona, Arizona The deadline for online registration is Friday, November 13, 2020 at noon Central. After 11/13/2020, registration will be available on-site at the meeting. Please select the category that best describes your status: Select One Rheumatologist Physician Nonphysician Provider Other Medical Professional Fellow Researcher Resident Full-Time Administrator Student/Trainee Industry Employee Other Fellowship/Residency Program: Expected Graduation Year: Select One 2020 2021 2022 2023 2024 2025 How did you learn about this conference? Select One Advertisement in Professional Journal Calendar/Monthly Listing Email Registration Brochure Mailer Website Word of Mouth/Colleague Please Check ALL Areas of Practice Emphasis: (Check all that apply) Ankylosing SpondylitisPsoriatic ArthritisFibromyalgiaRheumatoid ArthritisGoutSclerodermaLupusSjogren’s SyndromeOsteoarthritisDoes Not Apply Membership Application AURA Membership Dues (Join or Renew Today) and Attend the AURA 2020 Annual Meeting. If you pay the membership fee, you may register for the meeting complimentary. I am applying for membership as a: Physician Member $25 Nonphysician Member $25 Resident/Fellow Member No Charge Registrant Information Address Type: HomeOffice Meeting Registration Registration Categories Fees Member - Physician Complimentary Member - Nonphysician Complimentary Nonmember - Physician $50 Nonmember - Nonphysician $50 Nonmember - Allied Health Professionals $50 Student Complimentary Resident Complimentary Fellow Complimentary Industry Employee - Supporting Industry Employee whose company is already supporting AURA OR Industry Medical Science Liaison (Proof of MSL Title may be required before confirmation of registration) $175 Industry Employee - Non-Supporting Industry Employee whose company is NOT already supporting AURA $1,250 Your submission will need to be approved prior to confirmation of your registration. Approval may be based on current Industry support. To find out if your company is currently supporting AURA please contact Brittany Gyuricza in the Registration Department at (847) 264-5963 or email at firstname.lastname@example.org. Special Events Will you be attending the Annual Dinner on Saturday, December 5, 2020? Select One Yes No Please indicate how many additional guests you will be bringing to the Annual Dinner: # of adult tickets = 0 1 2 3 4 5 6 # of child tickets = 0 1 2 3 4 5 6 Note: Children with a child ticket will receive a kid-friendly plated meal. TOTAL REGISTRATION FEE: AURA requires payment for registration fees by check or credit card. Payment Information (must be made in U.S. dollars) CheckCredit Card -- Select Card -- Visa MasterCard American Express If paying by check, make check payable to: Arizona United Rheumatology Alliance Mail payment to: Arizona United Rheumatology Alliance Two Woodfield Lake 1100 E. Woodfield Road, Suite 350 Schaumburg, IL 60173 I have read, understood and agree to the electronic delivery of the data collected and payment amount. SIGNATURE: By selecting “I Agree” I represent and acknowledge that: I have read, understood, and consented to electronic delivery of the data collected and payment entered above. I have granted authorization to AURA in association with WJ Weiser & Associates, Inc. to charge the amount indicated on the credit card provided. I am the authorized user of the credit card listed above and that the associated information entered (account holder name, account number, billing address, etc.) is accurate. I intend the act of selecting “I Agree” to be my legal signature to this agreement. Enter in the Following Security Code: 881808 This question is for testing whether you are a human visitor and to prevent automated spam submissions.