Outpatient Surgery Magazine

Registration Form Marriott Harbor Beach Resort and Spa • October 3-5, 2018 First Name: __________________________________________________ Last Name:________________________________________________ Degree(s): ___________________________________________________ Title: ____________________________________________________ Facility/Company: _______________________________________________________________________________________________________ Address: _____________________________________________________________________________________________________________ Address: __________________________________________ City/State/ZIP: _______________________________________________________ Phone: ____________________________________________ Attendee's E-mail: ____________________________________________________ To register, please print or type the information below and mail or fax as directed. Please use one form per attendee. • Online: Please visit www.orexcellence.com to register online. Please call (888) YOUR-ORX with any issues or questions. • Mail: Make checks payable to AORN, Inc. and mail to AORN, Inc., Dept. 1385, P.O. Box 17180, Denver, CO 80217 • Fax: Fax registration form with credit card information to 844-241-4050 PAYMENT INFORMATION ❑ Enclosed is a check payable to AORN, Inc. Check #: _____________ ❑ I authorize AORN, Inc., to charge my: ❑ American Express ❑ Mastercard ❑ Visa ❑ Discover Credit Card Number: ______________________________________________ Expiration Date: ___________ 3 or 4 Digit Security Code: ________ Printed Cardholder Name:______________________________________________ Signature: __________________________________________________________ Type your name if completing online Cancellation Policy: If your cancellation is received in writing on or before August 17, 2018, your refund will be granted, less a $50 administration fee. If your cancellation is received between August 17, 2018 and September 21, 2018, your refund will be granted, less a $150 administration fee. There will be no refunds after September 21, 2018. CONFERENCE REGISTRATION AND PAYMENT INFORMATION Please complete one form per attendee. A multiple attendee discount is offered for registrants from the same facility. Check the appropriate box below (please only check one box). FULL CONFERENCE REGISTRATION FEES* Price until 8/17/18 ❑ I am registering for myself or as the primary attendee from my facility $675 pp $ ___________ ❑ I am registering as an additional attendee from my facility $575 pp $ ___________ Primary attendee's name: __________________________________________ Guest** Passes for Exhibit Hall Events (Exhibit hall events are free for attendees. Please only purchase if bringing an additional guest to the exhibit hall): Exhibit Hall Guest Pass (# guests) _____ @ $50 pp $ ___________ Guest's Name (First/Last): __________________________________________ Total fee for your registration, and guest fee, if any. $ ___________ If you are paying for additional attendees from your facility, please enter the total charges for them here. $ ___________ Grand total to be charged $ ___________ * Partial/daily rates are available on our website when you register. Please visit our website at www.orexcellence.com or call us for additional information. **Guest Policy: Significant others and guests of attendees are welcome to participate in our exhibit hall events. However, guests may not be surgical market vendors or consultants. There will be a strict "no soliciting" policy for guests. Commercial passes are available for vendors and consultants wishing to meet exhibitors and guests. PREFERRED CONFERENCE QUESTIONS For additional information or questions regarding the conference, please email us at orxmanager@outpatientsurgery.net or call (888) YOUR-ORX Credit card payments will only be accepted via fax (844-241-4050) or U.S. mail. Email submissions with credit card information will not be accepted. WORKSHOPS (pick one from each group - no additional charge!): CASC ATTENDEES ❑ Check here if you need AEU credits for CASC HOTEL RESERVATIONS Please contact the hotel directly to make your reservation, or use the link on www.orexcellence.com. Please mention OR Excellence Conference in order to receive the discounted group rate of $219 (Sgl/Dbl). Group rate is exclusive of appropriate state and local taxes, fees and assessments. Discounted rates apply until Sept. 9, 2018, or until all rooms in the group block have been reserved, whichever occurs first. After Sept. 9 th , guest rooms and discounted group rates may not be available. Confirm your reservations early to avoid any confusion and secure your room. Marriott Harbor Beach Resort and Spa 3030 Holiday Drive, Fort Lauderdale, FL 33316 Reservations: (954) 525-4000 Group Name: OR Excellence Conference Group Rate: $219 (Single/Double) Thurs PM Workshops: q A. Break Your Anesthesia Team of 10 Annoying Habits q B. A Millennial Nurse Uncovers the Truth About Millennial Nurses q C. 25 Answers to Questions You were Afraid to Ask Wed AM Workshops: q A. Yes, We Built a Total Joints Surgery Center q B. You're Not a Born Leader! q C. Sexual Harassment & Violence in the OR: A Panel Discussion 0 0 0

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