Registration/Membership Form

Registration is now open for the March 9, 2012 conference

Registration includes meeting attendance, light breakfast, boxed lunch, and breaks.

Last Name*: First Name*:
Institution*:
Work Address*:
City*: State*:
Postal/Zip Code*:
Phone*: Fax:
E-mail Address*:

*Required Field

For any questions dealing with COIDSA conference registration and/or membership or for more information about COIDSA, please contact Andrea Fuller at coidsa@gmail.com.

Registration Fees

CATEGORY REGISTRATION FEES
Physician Meeting Attendance & Annual Dues
Non-Physician Meeting Attendance & Annual Dues
Physician and Non-Physician Annual Dues
Fellow Meeting Attendance & Annual Dues

Clicking the Send Registration Data to COIDSA button below only registers you for the conference and/or membership with COIDSA and does not pay for the registration. Please use the secured Add to Cart button at the bottom of the page summarizing your registration to make your payment.