Online Registration Ohio Association of Rheumatology 15th Annual Meeting August 28 – 29, 2020 Hilton Downtown Columbus Ohio Columbus, OH The deadline for discounted early registration is Thursday, August 6, 2020. After 8/6/2020, regular registration fees will apply to online and on-site registration. Online Registration will be open through Monday, August 17, 2020 at noon Central. After this date, registration will be available on-site at the meeting. Please select the category that best describes your status: --Select-- Rheumatologist Industry Employee Fellow Full Time Administrator Advanced Practice Provider Registered Nurse Other Other Medical Professional Physician Researcher Resident Student/Trainee Fellowship/Residency Program: Expected Graduation Year: --Select-- 2020 2021 2022 2023 2024 2025 How did you learn about this conference? --Select-- Calendar/Monthly Listing Email Registration Brochure Mailer Please Check ALL Areas of Practice Emphasis: (Check all that apply) Ankylosing SpondylitisPsoriatic ArthritisFibromyalgiaRheumatoid ArthritisGoutSclerodermaLupusSjogren’s SyndromeOsteoarthritisDoes Not Apply OAR MEMBERSHIP APPLICATION If you pay the membership fee, you may register for the meeting complimentary. I am applying for membership as a: Physician $75 Non Physician Provider (e.g. RN, NP, Practice Manager) $25 Registrant Information Address Type: HomeOffice Meeting Registration Registration Categories Early Discounted through 8/6/2020 Regular Fees after 8/6/2020 Member Physician Complimentary Complimentary Member Nonphysician Provider Complimentary Complimentary Nonmember Physician $100 $125 Nonmember Nonphysician Provider $50 $75 Fellow Complimentary Complimentary Student Complimentary Complimentary Resident Complimentary Complimentary Industry Employee - Supporting/MSL Industry Employee whose company is already supporting OAR 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 OAR $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 OAR, please contact Brittany Gyuricza in the Registration Department at (847) 264-5963 or by email at email@example.com. Breakout Sessions The OAR 15th Annual Meeting will present two sets of breakout sessions on Saturday, August 29. Please indicate which OAR Saturday breakout session you will be attending: Saturday Morning from 9:00 a.m. – 12:00 p.m. OAR Advocacy SessionRheumatology Issues for Nonphysicians Session Saturday Afternoon from 1:00 p.m. – 4:00 p.m. OAR Scientific SessionOperational Issues for Practice Managers Session Additional Tickets (Not included in registration fee) Additional Evening Function Tickets for Non-Registered Guests Welcome Reception† # of tickets = 0 1 2 3 at $25 per ticket † One ticket to the Welcome Reception is included in attendee registration; please only select the ticket below if you are bringing a guest. I am planning on attending the OAR Lifetime Achievement Award Dinner†† --Select-- Yes No OAR Lifetime Achievement Award Dinner - Guest†† # of tickets = 0 1 2 3 at $25 per ticket †† One ticket to the OAR Lifetime Achievement Award Dinner is included in attendee registration; please only select the ticket below if you are bringing a guest. TOTAL REGISTRATION FEE: The OAR requires full payment for registration fees and optional activities 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: Ohio Association of Rheumatology Mail payment to: Ohio Association of Rheumatology 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 OAR 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 Security Code: 456539 This is to test whether you are a human visitor and to prevent automated spam submissions. Registration Cancellation and Refund Policy Registration refund requests must be submitted in writing to the OAR Executive Office by August 6, 2020. All refund requests will be subject to a $10 processing fee. No refunds will be made after 8/6/2020.