Meeting Registration FSO-HNS/FSFPRS Physician Registration 1Begin Registration2Your Information3Meeting Registration4RSVP5Friday Evening Out - Margaritaville6Saturday Pre-Game BBQ Lunch7Payment & Consent Confirmation ID Your InformationFull Name* Salutation Dr.MissMr.Mrs.Ms.Prof.Rev. First Last Credentials* M.D. D.O. Medical License Number* Licensed State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificPractice Name / Affiliation* Mobile Phone Number*Email Address* Password* Password must be at least 6 characters long. Show/Hide PasswordYour email address and password creates your FCOM2022 account. You will be able to update your attendee profile, view your agenda, watch sessions and more!Food AllergiesPlease let us know if you or your guests have any food allergies we should be aware of. Physician Registration Registration Fee: $575.00 FSO-HNS/FSFPRS Discount: - $200.00 Total Registration Fee FCOM Registration - FSO-HNS/FSFPRS Member Physician Friday, November 11, 2022Select the activities that you will attend on this day. Friday Morning Educational Session (8:00 AM – 12:00 PM) Friday Lunch, EXPO & Product Theatres (12:00 PM – 1:00 PM) Friday Afternoon Educational Sessions (1:00 PM – 5:30 PM) Welcome Reception (5:30 PM – 7:00 PM) Friday Evening Out - Margaritaville (7:00 PM – 9:30 PM) Ticketed Event Select AllSaturday, November 12, 2022Select the activities that you will attend on this day. Saturday Morning Breakfast, EXPO & Product Theatre (7:00 AM – 8:00 AM) Saturday Educational Sessions (8:00 AM – 1:30 PM) Saturday Pre-Game BBQ Lunch in EXPO (1:30 PM – 2:30 PM) Included w/ Registration Resident Bowl (3:00 PM – 4:30 PM) Select AllSunday, November 13, 2022Select the activities that you will attend on this day. Sunday Morning Breakfast, EXPO & Product Theatre Sunday Morning Education Sessions (8:00 AM – 10:45 AM) Final EXPO and Grand Prize Drawings (10:45 AM – 11:30 AM) Select All Will you be attending the Friday Night Dinner event? Yes No Friday Night Dinner Event (Attendee) Price: Speakers have a free entry included with their meeting registration for the Friday Night Event!Board Members have a free entry included with their meeting registration for the Friday Night Event!Will you be bringing a guest to the Friday Night Dinner event?You are allowed one complimentary guest with your registration. Yes No Friday Night Dinner Event (Complimentary Guest) Price: Will you be bringing any other additional paid guests to the Friday Night Dinner event? Yes No Number of Guest (Adults)Please enter a number from 0 to 5.Friday Night Dinner Event (Additional Guest - Adult) Price: Number of Guest (Children)Please enter a number from 0 to 5.Friday Night Dinner Event (Additional Guest - Children) Price: Total Cost for Friday Night Dinner Event $0.00 Will you be attending the Saturday Pre-Game BBQ Lunch event?Saturday Pre-Game BBQ Lunch event is included for all registered attendees. Any accompanying guests will incur an additional fee. Yes No Saturday Pre-Game BBQ Lunch (Attendee) Price: Will you be bringing any guests to the Saturday Pre-Game BBQ Lunch event? Yes No Number of Guests (Adults)Please enter a number from 0 to 5.Saturday Pre-Game BBQ Lunch (Additional Guest - Adult) Price: Number of Guests (Children)Please enter a number from 0 to 5.Saturday Pre-Game BBQ Lunch (Additional Guest - Children) Price: Total Cost for Saturday Pre-Game BBQ Lunch Event $0.00 {order_summary}Total (Registration Fee + Add-Ons) Credit Card Details*Card Details Cardholder Name Meeting Consent*By submitting this registration form and creating your account on the FCOM platform, you agree to the meeting's policies and terms & conditions. I agree to all Florida Combined Otolaryngology Meeting Policies and Terms and Conditions.
