Online Conference Registration

Registration Fees:

	Early Bird	After 8/9
MD/DO	$350	$385
ANP/PA	$260	$285
RN/other	$200	$225
Medical Resident	$0	$0

Dinner tickets for the dinner program are $50.

Registrant Information

First name:*

Last name:*

Professional title:*

Organization:

Address:

Address2:

City:*

State:*

Zip:

Country:*

Email:*

(E-mail)

Phone:*

Dietary restrictions:

All participants will receive a thumb drive with the program slides and handouts.
Check here if you would prefer a paper copy of the slides/handouts. (additional $30)

Dinner Ticket?:

$50 each

Emergency contact:*

Emergency contact phone:*

I am fully vaccinated for covid 19. If not, I can show proof on antibodies or agree to provide evidence of a negative PCR test taken 72 hours prior to the conference.*

In consideration of my being allowed to attend and participate in the Wheezin', Sneezin' & Itchin' in Alaska being held by AAFA Alaska at the Hotel Alyeska September 10 & 11, 2021 (the “Conference”), I, the undersigned, acknowledge and agree that I am familiar with the Centers for Disease Control and Prevention guidelines regarding COVID-19. I understand that attendance at and participation in the Conference and related activities may increase my risk and my guests’ risk of contracting or passing on COVID-19. While personal compliance with the guidelines may reduce this risk, the risk of serious illness and death does exist from the disease. I take responsibility for my attendance and participation in the Conference and related activities. I release AAFA-AK from any liability if I were to become infected

I have read and agree to the above waiver*