Registration
Secure online below
By Phone: 212.629.9770 / 732.866.4444
By Fax: 212.629.5652 / 732.866.8408
By Mail: Kidney & Urology Foundation of America
63 West Main Street, Suite G
Freehold, NJ 07728
Attention: Lupus Conference
www.kidneyurology.org

Hotel Accommodations: A limited number of rooms are reserved for meeting attendees at a special group rate starting at $295 [plus applicable taxes] at The Lucerne Hotel, 201 West 79th Street, New York, NY 10024. To make your reservation, please call The Lucerne Hotel Reservations at 800-492-8122 or 212-875-1000, or email reservations@thelucernehotel.com. Please reference group name Kidney and Lupus Conference and number 258950. All calls or emails must be received by October 29, 2018 to guarantee this rate.

Registration

Conference Registration Fees:

(quantity) MDs at $150
Names/Titles:

(quantity) PAs at $75
Names/Titles:

(quantity) Nurses at $75
Names/Titles:

(quantity) Other Allied Health Professionals at $75 (Other: )
Names/Titles:

(quantity) Residents, Fellows, Students at $50
Names/Titles:


 
First Name
Middle Initial
Last Name
Degree
Affiliation
Address
Address 2
City
State
Zip
Country
Telephone
--   Ext.
Fax
--
Email Address
Specialty:
How did you learn about our program? (Check one) Email about this event
Direct mailing
Recommended by my colleague
Facebook
Other
If other, please explain:
Comments:
(Special Requests)
 
Credit Card Number
Credit Card Expiration
/
Name On Card
CVV Security Code
 
 

You will receive a confirmation via your provided email.

For further information, please call 732.866.4444 or cbrower@kidneyurology.org.

   
 

Kidney & Urology Foundation Home
Kidney & Urology Foundation of America
© 2018