Online Registration

Any questions regarding online registration
please call 612-623-3268
 

Registration
Name
AOA#  
Address
Address 2
City
State
Zip
Email Address
Phone  
 (Example 6126233268)
Fax
(Example 6126233268)
Degree  
Specialty

Registration Fees
   

BEFORE
April 11

AFTER
April 11

  
MOMS Member $350 $375  
Non- Member $375 $400  
Allied Health
(PA, RN, NP)		 $135 $155 `
Retired Physician $75 $75  
Student/Intern Resident FREE FREE  

Add on Functions
         
Breakfast with Dr.
Kuchera		 FREE  
Ruth's Chris Dinner $100 per couple $75 Per single
  Number of People  
A Midsummer Night's Dream $54.25 Per Person
  Number of People  

Payment Method
Visa
MasterCard
Discover
Cardholder Name  
Card Number  
Expiration Date  

Any questions regarding online registration
please call 612-623-3268