Registration Southeastern Section of the AUA, Inc. 84th Annual Meeting March 18 - 21, 2020 The Roosevelt New Orleans, A Waldorf Astoria Hotel New Orleans, LA The deadline for discounted early registration is Thursday, February 20, 2020. After 2/20/2020, regular registration fees will apply to online and on-site registration. Registration fees are subject to change. To lock in these rates, register now! Online Registration will close on Friday, March 6, 2020 at noon CT. Please select the category that best describes your status: --Select-- Industry Employee Fellow Full Time Admin Nonphysician Provider Other Other Medical Professional Physician Researcher Resident Student/Trainee Urologist Urology Fellow Urology Resident Fellowship/Residency Program: Expected Graduation Year: --Select-- 2019 2020 2021 2022 2023 2024 2025 How did you learn about this conference? --Select-- Advertisement in Professional Journal Calendar/Monthly Listing Email Member Newsletter Registration Brochure Mailer Website Word of Mouth/Colleague Please Check ALL Areas of Practice Emphasis: (Check all that apply) AndrologyOncologic Urology - KidneyBenign Prostatic DiseaseOncologic Urology - ProstateCalculus DiseaseOncologic Urology - PenileCryosurgeryOncologic Urology - RenalEndourologyOncologic Urology - TesticularFemale UrologyOncologic Urology - All formsFetal UrologyPediatric UrologyGeriatric UrologyReconstructive UrologyIncontinence - FemaleRenal TransplantationIncontinence - MaleRoboticsLaparoscopySexual Medicine - FemaleNeurourologySexual Medicine - MaleOncologic Urology - BladderDoes Not Apply Registrant Information Address Type: HomeOffice Meeting Registration Registration Categories Early Discounted through 2/20/2020 Regular Fees after 2/20/2020 SESAUA Member/Initiate $490 $540 SESAUA Senior Member $395 $445 Nonmember Urologist (Non-SESAUA member/Other AUA section member) $490 $540 Nonmember Physician (Non-SESAUA member/Non-AUA member) $580 $630 SESAUA Resident (AUA candidate member) $0 $0 SESAUA Fellow (AUA candidate member) $0 $0 SESAUA Medical Student $0 $0 Nonphysician Provider $295 $345 Please indicate if you are a: --Select-- Nurse Nurse Practitioner Physician Assistant Industry Employee - Supporting/MSL Industry Employee whose company is already supporting SESAUA OR Industry Medical Science Liaison $630 (Proof of MSL Title may be required before confirmation of registration) Industry Employee - Non-Supporting Industry Employee whose company is NOT already supporting SESAUA $1,050 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 SESAUA please contact Brittany Gyuricza in the Registration Department at (847) 264-5963 or by email at firstname.lastname@example.org. Spouse/Guest Registration Spouse/Guest 0 1 2 3 $250 $300 Child Registration up to 17 years of age 0 1 2 3 $89 $139 Spouse/Guest 1 Guest 2 Guest 3 Additional Evening Function Tickets for Non‑Registered Guests One ticket is included with attendee and guest registrations. Please only purchase additional tickets if you are not registering a guest for the entire meeting. Welcome Reception (Adult) 0 1 2 3 @ $150 per ticket Welcome Reception (Child) 0 1 2 3 @ $0 per ticket Closing Reception 0 1 2 3 @ $85 per ticket TOTAL REGISTRATION FEE: The SESAUA 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-- Visa MasterCard American Express If paying by check, make check payable to: Southeastern Section of the AUA Mail payment to: Southeastern Section of the AUA, Inc. 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 SES 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: 741738 This question is for testing 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 SESAUA Executive Office by 2/20/2020. All refund requests will be subject to a $50 processing fee. No refunds will be made after 2/20/2020.