SWIU Clinical Mentoring Conference Registration Form
January 13 – 15, 2012

The deadline for discounted early registration is 12/13/11.
After 12/13/11, regular registration fees will apply to online & on-site registration.
Registration Fees are subject to change. To lock in these rates, register now.

NOTE: If you are employed by industry and your company is not exhibiting at the 2012 SWIU Conference but would like to register to attend this conference, please contact JP Baunach at (847) 264-5942 or by email jp@wjweiser.com in the SWIU executive office to confirm your registration.
     
Thank you for your interest in attending the upcoming Conference. The online registration is now closed; however, onsite registration will be available.
 

MEETING REGISTRATION
Registration Categories

   
Early Discounted
(through 12/13/11)
Regular Fees
(after 12/13/11)
Member  
$250
$300
Non-Member  
$300
$350
Resident/Fellow  
$100
$150
       
Industry – If you are an employee of industry, you must register in one of these two categories:
Industry Employee (Company IS a 2012 SWIU Exhibitor)
$250
 
Industry Employee (Company is NOT a 2012 SWIU Exhibitor)
If you are NOT a 2012 Exhibitor, please contact JP Baunach in the SWIU Industry Relations office at (847) 264-5942 for details.
 
ADDITIONAL TICKETS (Not included in registration fee)
Additional Evening Function Tickets for Non-Registered Guests:
*One ticket to each is included in your registration fee. If you plan on bringing a guest, you may purchase tickets here.
 
Welcome Reception @ $25 per tickect  
President's Dinner @ $75 per tickect  
 
 
 
PAYMENT INFORMAION
The Society of Women in Urology requires payment for registration fees and full payment of optional activities by check or credit card.
Registration Cancellation & Refund Policy
Registration refund requests must be submitted in writing to the SWIU Executive Office by 12/13/11. All refund requests will be subject to a $50 processing fee. No refunds will be made after 12/13/11.