Conference Materials

TO REGISTER: CALL 800 417 2035 • FAX 866 678 5755 • REGISTRATION@BECKERSHEALTH- CARE. COM OR VISITwww.beckersasc.com/june-conference 150 SPINE AND ORTHOPEDIC SURGEONS AND PAIN MANAGEMENT PHYSICIAN SPEAKERS, OVER 250 SPEAKERS TOTAL REGISTRATION INFORMATION REGISTRATION FEES REGISTRATION FORM Photocopies are acceptable. Please print or type below. Please use a separate registration form for each attendee. This exclusive spine, orthopedic and pain management-focused ASC conference brings together surgeons, physician leaders, administrators and ASC business and clini- cal leaders to discuss how to improve your ASC and its bottom line and how to manage challenging clinical, business and financial issues. Learn more at this three day event than anywhere else. CONTINUING EDUCATION More Information on CMEs Coming Soon! HOTEL RESERVATIONS The Swissotel Chicago has set aside special group rates for conference attendees. To make a reservation, please visit: https://book.passkey.com/go/BeckersHealth The Swissotel Chicago 323 East Wacker Drive Chicago, IL 60601 (888) 737-9477 CONFERENCE QUESTIONS For additional information regarding the conference, exhibiting or sponsoring please contact: Becker's Healthcare Phone: 800-417-2035 Fax: 866-678-5755 Email: registration@beckershealthcare.com ADA REQUEST If you require special ADA accommodations, please contact us at 800-417-2035. ONLINE REGISTRATION One reasonable price One reasonable price Come for as much of the conference as you would like! www.beckersasc.com/june-conference TO REGISTER: CALL 800 417 2035 • FAX 866 678 5755 • REGISTRATION@BECKERSHEALTHCARE.COM OR VISIT www.beckersasc.com/june-conference COMPLETE REGISTRATION FORM AND MAIL OR FAX AS FOLLOWS: Online: Fax: Fax registration form with credit card information to 866-678-5755 Call: Call 800-417-2035 to register by phone Email: registration@beckershealthcare.com Cancellation Policy: Written cancellation requests must be received within 120 days of transaction or by Ma. 1, 2020, whichever is first. Refunds are subject to a $100 processing fee. Refunds will not be made after this date. Multi-Attendee Discount Policy: To be eligible for the discount, your hospital must be registered at one time and work at the same address. Just copy the registration form for each attendee. Employees from a second location are not eligible for the discount. BECKER'S 18TH ANNUAL SPINE, ORTHOPEDIC AND PAIN MANAGEMENT-DRIVEN ASC + THE FUTURE OF SPINE CONFERENCE JUNE 18-20, 2020 • SWISSOTEL • CHICAGO, ILLINOIS ANNUAL CONFERENCE & EXHIBITS – One reasonable registration price - come for as much of the conference as you would like! Receive multiple registrant discounts. The more people you send, the greater discount you receive. The prices listed below are per person. Your registration includes all conference sessions, materials and the meal functions. MAIN CONFERENCE ONLY FEES AMOUNT FEES AMOUNT (Before 4/1/20) (After 4/1/20) 1st Attendee $800 $ __________________ $900 $ _______________ 2nd Attendee $775 $ __________________ $875 $ _______________ 3rd Attendee $750 $ __________________ $850 $ _______________ 4th Attendee or more $725 $ __________________________ $825 $ _______________ (Ask about larger group discounts) TOTAL ENCLOSED $________________________________ c I authorize to charge my: c c c Credit Card Number: __________________________________ Expiration Date: _____________________ Printed Cardholder Name: _____________________________ Zip Code: ___________________________ Cardholder Billing Address: ___________________________ City/State/Zip:_______________________ Signature: ______________________________________________ CVV#/3-digit #:______________________ First/Last Name: ________________________________________________________________________________________ Degree/Designations (As you wish it to appear on your badge): _______________________________________ Title: ___________________________________________________________________________________________________ Facility/Company: _____________________________________________________________________________________ Address: _______________________________________________________________________________________________ City/State/Zip: _________________________________________________________________________________________ Phone:__________________________________ Fax: ________________________________________________________ Email:__________________________________________________________________________________________________ GENERAL INFORMATION TO REGISTER PAYMENT INFORMATION

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