Registration Form

Online Registration

KRA 2017 Annual Meeting

October 21, 2017
Hilton Garden Inn Louisville Airport
Louisville, KY

Online registration will be available until 10/11/2017.
Afterwards, registration will be available onsite.


Registration fees are subject to change. To lock in these rates, register now.
  • Please select the category that best describes your status:*

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



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Membership Application

KRA Membership Dues (Join or Renew Today) and attend
the KRA Annual 2017 Meeting complimentary!

  • $50

*If you pay the membership fee, you may register for the meeting complimentary.


Registrant Information

  • First Name:*
  • Last Name:*
  • Degree(s):
  • Badge First Name:*
  • Address 1:*
  • Address 2:
  • City:*
  • State:*
  • Zip Code:*
  • Country:*
  • Phone:*
  • Fax:
  • Email:*
  • Address Type:*

Meeting Registration*

  • Complimentary
  • $50
  • $25
  • Complimentary
  • Complimentary
  • Complimentary

  • Industry Employee whose company is already supporting KRA OR Industry Medical Science Liaison (Proof of MSL Title may be required before confirmation of registration)
  • $175

  • Industry Employee whose company is NOT already supporting KRA
  • $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 KRA, please contact Brittany Kallman in the Registration Department at (847) 264-5963 or by email at brittany@wjweiser.com.
  • TOTAL REGISTRATION FEE:

The KRA requires full payment for registration fees by check or credit card.

Payment Information (must be made in U.S. dollars)

Please note: If paying by credit card, the name WJ Weiser & Associates (the management company of Kentuckiana Rheumatology Alliance) will appear on your statement.

  • Billing Address:*
  • ZIP:*
  •  
  • Card Type:*
  • Name on Card:*
  • Card Number:*
  • Expiration Date: (mmyy)*
  • Card Verification #:*

If paying by check, make check payable to: WJ Weiser & Associates.

Mail payment to:
Kentuckiana Rheumatology Alliance
Two Woodfield Lake
1100 E. Woodfield Road, Suite 350
Schaumburg, IL 60173

  • Enter Security Code: 8071

Registration Cancellation and Refund Policy

Registration refund requests must be submitted in writing to the KRA Executive Office no later than 9/18/2017. All refund requests will be subject to a $10.00 processing fee. No refunds will be made after 9/18/2017.