Application for Annual Meeting Attendance | Ohio Dermatological Association

Name *

First

Middle

Last

Degree *

Other Degree

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone Number *

Registration Type *

Syllabus Preference (ODA members only) *

MOC General (Fri 3:30-4:30 pm) *

Medical Students may attend the General Session Only. Registration does not include MOC.

MOC Surgical (Fri 4:45-5:45 pm) *

Medical Students may attend the General Session Only. Registration does not include MOC.

Friday Cosmetic Workshop *

Friday Exhibitor Reception *

Saturday luncheon *

Saturday Evening Gala Event - Member Registration

Saturday Evening Gala Event - Member GUEST Registration

Saturday Evening Gala Event - Resident/Medical Student Registration

Saturday Evening Gala Event - Resident/Medical Student GUEST Registration

Donation - Ohio Dermatological Shade Structure

Donation - Ohio Dermatological Foundation - Resident/Medical Student Gala Event Support

If you would like to donate an amount not listed above, please contact Jill Hostetler at 330.465.8281 or via email at odaexec@ohderm.org

By registering online, I designate 20 percent of my registration fee as a donation to the Ohio Dermatological Foundation.

(NOTE: This does NOT increase your payment - your contribution helps the ODF maintain its charitable status.)

Total

$ 0.00

Ohio Dermatological Association