Emory Advances in Urology Course

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Registration Form

Online Registration

Emory Department of Urology
and Emory University School of Medicine
Present

Advances in Urology Course

December 8 – 9, 2017
W Hotel — Buckhead
Atlanta, Georgia


Thank you for your interest in attending the Emory Advances in Urology Course.
Online registration is now closed; however, on-site registration will be available.
  • Please select the category that best describes your status:*

Please Check ALL Areas of Practice Emphasis:* (Check all that apply)









INDUSTRY EMPLOYEES ONLY

Industry Employees who are interested in supporting Emory or attending this meeting should contact JP Baunach (jp@wjweiser.com) for more information.

Registrant Information

  • First Name:*
  • Last Name:*
  • Degree(s):
  • Badge First Name:*
  • Address 1:*
  • Address 2:
  • City:*
  • State:*
  • ZIP:*
  • Phone:*
  • FAX:
  • Email:*
  • Address Type:*

Meeting Registration*

  • Registration Categories
  • Early Fee
    Before 11/6/2017
  • Regular Fee
    After 11/6/2017
  • $425
  • $475
  • $300
  • $350
  • $0
  • $0
  • $0
  • $0
  • $0
  • $0
  •   (PA, RN or NP)
  • $150
  • $150

  • TOTAL REGISTRATION FEE:

Registration Cancellation and Refund Policy

Registration refund requests must be submitted in writing to the Emory Executive Office by 11/6/2017. All refund requests will be subject to a $50.00 processing fee. No refunds will be made after 11/6/2017.