2023 IOMA Upper Midwest Osteopathic Health Conference

First Name *

Last Name *

Title/Designation *

AOA Number

Clinic/Office Name *

Preferred Address *

Preferred Address 2

Preferred City *

Preferred State *

Preferred Zip *

Cell Phone *

Text message opt in

I am opting in to receiving text messages from IOMA & understand that SMS/data rates from my carrier may apply.

Work Phone

Email *

Preferred Name for Badge *

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Email *

Special Dietary Requirements

INTERESTED IN JOINING IOMA OR NEED TO RENEW YOUR IOMA MEMBERSHIP FOR 2023?

Add it on to your conference registration-- you might save money overall!

1st year in practice - $150

2nd year in practice - $250

3rd year in practice - $375

4th year & over in practice- $495

Out of State Member - $120

IOMA CONFERENCE REGISTRATION RATES

Are you attending all days of the conference?

I am attending the full conference

I am attending only specific day(s)

Full Registration Types

IOMA and/or Iowa Obesity Society Member - $550.00

Non-Member Physician - $675.00

Retired IOMA Member (no CME - if you need CME register at the IOMA member rate) - $275.00

Retired Non-Member Physician (no CME - if you need CME register at the IOMA member rate) - $345.00

Students, Residents, Fellows (no CME - if you need CME register at the IOMA member rate) - $25.00 per lunch

How many lunches will you attend? (please RSVP using the checkboxes below) *

Partial Registration Types

Thursday Member* - $275.00

Thursday Non-Member - $295.00

Friday General Session Member* - $275.00

Friday General Session Non-Member - $295.00

Friday Emergency Medicine Track Member* - $275.00

Friday Emergency Medicine Track Non-Member - $295.00

Saturday Member* - $275.00

Saturday Non-Member - $295.00

* Member of IOMA and/or Iowa Obesity Society

On Friday there will be 2 tracks (both are included in the registration fee) -- which track do you plan to attend? For details on both please see our schedule. *

General Session

Emergency Medicine Track

For all registration types, please indicate the days you plan to attend lunch: *

Thursday

Friday

Saturday

No Lunch Attendance

Sign me up for one of the SIM-IA hands-on simulation time slots on Saturday, May 6th ($30 additional fee, pending availability, for more information, please visit http://www.ioma.org/umoh-conference.cfm

Register

SIM-IA ($30)

How did you hear about our conference? *

Emails

IOMA Website

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GETTING INVOLVED

I’m interested in volunteering with IOMA - Please contact me!

If you have questions about registering for this meeting, please contact IOMA at ioma@ioma.org or 515-282-8192.

By submitting this online form, I understand and agree that IOMA will have my contact details for the purpose of processing my information and ensuring full participation.

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$

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IOMA Iowa Osteopathic Medical Association

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