Minnesota Osteopathic Medical Society

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 Sept 18	AFTER Sept 18
MOMS Member		$275	$300
Non- Member		$300	$325
Allied Health (PA, RN, NP)		$135	$155	`
Retired Physician		$75	$75
Student/Intern Resident		FREE	FREE
Add on Functions
Friday Group Activity	Number of People $30 Per Person
Payment Method
Visa
MasterCard
Discover
Cardholder Name
Card Number
Expiration Date

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

Contact: