Online Registration Arizona United Rheumatology Alliance 2020 Annual Meeting December 4 – 6, 2020 Enchantment Resort Hotel & Spa Sedona, Arizona Online Registration will be open through the end of the event on Sunday, December 6, 2020. Please select the category that best describes your status: --Select-- 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-- 2020 2021 2022 2023 2024 2025 How did you learn about this conference? --Select-- 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 AURA Membership Dues (Join or Renew Today) If you pay the membership fee, you may register for the meeting at the complimentary member rate! 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 In-Person Attendee In-Person - Member - Physician Complimentary In-Person - Member - Nonphysician Complimentary In-Person - Nonmember - Physician $50 In-Person - Nonmember - Nonphysician $50 In-Person - Nonmember - Allied Health Professionals $50 In-Person - Student/Resident/Fellow Complimentary Virtual Attendee Virtual - Member - Physician Complimentary Virtual - Member - Nonphysician Complimentary Virtual - Nonmember - Physician $50 Virtual - Nonmember - Nonphysician $50 Virtual - Nonmember - Allied Health Professionals $50 Virtual - Student/Resident/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-- Yes No Current restrictions limit gatherings to 50 or less persons. Due to this, AURA will prioritize attendee presence at the dinner. If there is room, please let us know if you would like to invite another person. Would like to invite a guest, if space allows? --Select-- Yes No 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: 281388 This question is for testing whether you are a human visitor and to prevent automated spam submissions.