"*" indicates required fields AdministrationHiddenDate MM slash DD slash YYYY Registrant InformationName* First Last Credentials (MD, DO, etc.) Group/Hospital* Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneEmail* Registration Fees2023 Annual Meeting Registration* 2023 WSOA Member (all types) or Speaker- Complimentary - $0.00 Student or Resident/Fellow - Complimentary - $0.00 Non-Member Physician (includes 2024 membership): $295 - $295.00 Non-Member Physician (all types - without membership): $100 - $100.00 Retired Physician - Complimentary - $0.00 Orthopaedic Admin: $50 - $50.00 Speaker - $0.00 Staff - $0.00 Coupon Total Payment Method Credit Card Check Check Number Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Note: If your registration fee is $0 your credit card will not be charged. Δ
