Hotel Reservations The Waldorf Astoria New York 301 Park Avenue New York, NY 10022
Call 877-GROUP-WA (47687-92) Reservation Deadline: August 15, 2013 Room Rate: Single/Double $369
Refer to the OSN New York meeting when reserving your room to take advantage of the reduced rate for attendees. Note: Reduced room rates do not guarantee room availability with the hotel. After August 15, 2013, room rates will be based on availability. Hotel rates are per room, per night and do not include tax/service. Currently, a 14.75% sales tax and a $3.50 per room, per night occupancy tax are applicable to the room rate. Such taxes are subject to change without notice.
Meeting Registration Form First/Given Name
Middle Initial
Last/Family Name
Degree
Address City
State/Province
Country
Zip/Postal Code
Phone
Fax Email
Special Dietary Request (please select one):
o Kosher style
Profession:
Primary Specialty:
Subspecialty/Area of Interest:
o Physician o Physician Assistant o Resident o Nurse o Other: ________________________
o Ophthalmology o Other: ________________________
o Cataract surgery o Contact lenses o Cornea/External disease o General ophthalmology o Neurosciences o Oculoplastics
o Optics o Pediatrics/Strabismus o Refractive surgery o Retina/Vitreous sciences o Other: ________________________
o Post card o Flyer o Brochure
o I’m a Past Attendee o Other: ________________________
o Vegetarian
o No preference
How did you hear about this meeting? (please select all that apply): o Internet Search o Letter o Word of Mouth
o Print Advertisement o Email o Exhibit Booth Priority Code: ____________________
Please enter the priority code found on the lower right-hand corner of your registration form or other marketing materials.
CME Activity Request o Yes, I would like the opportunity to earn CME credits through future activities sponsored by Vindico Medical Education.
Registration Type Early Bird Registration
Preregistration
Save up to $200 on or before June 3
Save up to $100 on or before August 5
Standard Registration
o B. Physician
$495
o C. Physician
$595
o D. Physician
$695
o E. Resident*
$345
o F. Resident*
$445
o G. Resident*
$545
*Residents/students must submit a letter of verification at time of registration.
Total Enclosed $ ____________
Payment Information o Enclosed is my check payable to “OSN New York 2013” paid in U.S. dollars, drawn on a U.S. bank. Please bill my:
o Visa
Account Number
o MasterCard
o American Express
Exp. Date
3-4 Digit Security Code
Signature Federal ID # 30-0747466 Cancellations: Requests for refunds must be submitted in writing by September 2, 2013. There will be a $200 service charge retained for all refund requests. Requests received after this date will be ineligible for refunds. ADA Compliance: In compliance with the Americans with Disabilities Act of 1990, we will make all reasonable efforts to accommodate persons with disabilities. Please call with your requests. Dress code for this meeting is business attire.
OSNNY.com
1-877-307-5225, ext. 219 or 476 or 856-848-1712, ext. 219 or 476 Office Hours: 9:00 am – 5:00 pm, ETMonday – Friday
OSN New York 2013 6900 Grove Road Thorofare, NJ 08086-9447 Email:
[email protected] Fax: 856-251-0278
12-1900
Register Today
ATTN: Registration Department
