NEFS - Annual Meeting RSVP

17th Annual Meeting ~ RSVP FORM ~ May 3-4, 2019

Name Prefix

First Name *

Last Name *

Title *

Institution/Affiliation *

Address Type

Address Country

Address 1 *

Address 2

Address City *

Address State

Address Zip Code *

Email Address *

Office Phone

Phone Country

Phone Number *

Cell Phone

Assistant's Contact Name

Assistant's Email Address

RATES:(please check below):

(ADULT Guests are friends and family members who accompany a full meeting restrant an may attend meals and social functions. Childrens rate includes Friday night activities AFTER dinner and activities and Saturday night kids meal)
**If you apply for membership before the meeting, you may receive the member rate registration. All registrations will be verified. Membership is good for the calendar year.

Hands On Workship rate is $0. The course will be held Friday, May 3rd from 9-3 before the annual meeting and includes a sitdown lunch. CME is being applied for additional credits. More info will be available soon. See Agenda for Workshop Agenda.

Guest's Name (Please list all)

Special Assistance

I require special assistance (wheelchair, auxiliary aids)

I have special dietary needs

Please explain your dietary needs below:

Dietary Needs or Additional Comments: