Outpatient Surgery Magazine

Registration Form Hyatt Regency New Orleans • October 3-5, 2019 First Name: __________________________________________________ Last Name:________________________________________________ Degree(s): ___________________________________________________ Title: ____________________________________________________ Facility/Company: _______________________________________________________________________________________________________ Address: _____________________________________________________________________________________________________________ Address: __________________________________________ City/State/ZIP: _______________________________________________________ Phone: ____________________________________________ Attendee's E-mail: ____________________________________________________ To register, please print or type the information below and mail or fax as directed. Please use one form per attendee. • Online: Please visit www.orexcellence.com to register online. Please call (888) YOUR-ORX with any issues or questions. • Mail: Make checks payable to AORN, Inc. and mail to AORN, Inc., Dept. 1385, P.O. Box 17180, Denver, CO 80217 • Fax: Fax registration form with credit card information to 844-241-4050 ❑ Enclosed is a check payable to AORN, Inc. Check #: _____________ ❑ I authorize AORN, Inc., to charge my: ❑ American Express ❑ Mastercard ❑ Visa ❑ Discover Credit Card Number: ______________________________________________ Expiration Date: ___________ 3 or 4 Digit Security Code: ________ Printed Cardholder Name:______________________________________________ Signature: __________________________________________________________ Type your name if completing online Cancellation Policy: If your cancellation is received in writing on or before August 15, 2019, your refund will be granted, less a $50 administration fee. If your cancellation is received between August 15, 2019 and September 15, 2019, your refund will be granted, less a $150 administration fee. There will be no refunds after September 15, 2019. CONFERENCE REGISTRATION AND PAYMENT INFORMATION Please complete one form per attendee. A multiple attendee discount is offered for registrants from the same facility. Check the appropriate box below (please only check one box). FULL CONFERENCE REGISTRATION FEES* ❑ I am registering for myself or as the primary attendee from my facility $675 pp (until 9/1/19. $775 after) __________$ ❑ I am registering as an additional attendee from my facility $575 pp (until 9/1/19. $675 after) __________$ Primary attendee's name: __________________________________________ Guest** Passes for Exhibit Hall Events (Exhibit hall events are free for attendees. Please only purchase if bringing an additional guest to the Exhibit Hall): Exhibit Hall Guest Pass (# guests) _____ @ $50 pp $ ___________ Guest's Name (First/Last): __________________________________________ Total fee for your registration, and guest fee, if any. $ ___________ If you are paying for additional attendees from your facility, please enter the total charges for them here. $ ___________ Grand total to be charged $ ___________ * Partial/daily rates are available on our website when you register. Please visit our website at www.orexcellence.com or call us for additional information. **Guest Policy: Significant others and guests of attendees are welcome to participate in our - events. However, guests may not be surgical market vendors or consultants. There will be a strict "no soliciting" policy for guests. Commercial passes are available for vendors and consultants wishing to meet exhibitors and guests. PREFERRED CONFERENCE QUESTIONS For additional information or questions regarding the conference, please email us at orxmanager@outpatientsurgery.net or call (888) YOUR-ORX. PAYMENT INFORMATION Credit card payments will only be accepted via fax (844-241-4050) or U.S. mail. Email submissions with credit card information will not be accepted. WORKSHOPS (pick one - no additional charge!): CASC ATTENDEES ❑ Check here if you need AEU credits for CASC HOTEL RESERVATIONS Please contact the hotel directly to make your reservation, or use the link on www.orexcellence.com. Please mention OR Excellence Conference in order to receive the discounted group rate of $239 (Sgl). Group rate is exclusive of appropriate state and local taxes, fees and assessments. Discounted rates apply until Sept. 9, 2019, or until all rooms in the group block have been reserved, whichever occurs first. After Sept. 9, guest rooms and discounted group rates may not be available. Confirm your reservations early to avoid any confusion and secure your room. Hyatt Regency New Orleans 601 Loyola Ave, New Orleans, LA 70113 Reservations: (504) 561-1234 Group Name: OR Excellence Conference Group Rate: $239 (Single) Thurs AM Workshops: q A. Get What You Need From Your Anesthesia Team q B. Build a World-Class Total Joints Program q C. Maximizing Surgical Service Line Profitability

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