Seminar Speaker Registration

Registration Type*

Undergraduate Student Conference Registration (copy of valid ID required) $50
Undergraduate Student Virtual Registration (copy of valid ID required) $25
Graduate Student Conference Registration (copy of valid ID required) $100
Graduate Student Virtual Registration (copy of valid ID required) $50
Graduate Student 8th Anniversary Registration (copy of valid ID required) $250
Resident/Fellow Conference Registration (copy of valid ID required) $125
Resident/Fellow Virtual Registration (copy of valid ID required) $60
Resident/Fellow 8th Anniversary Registration (copy of valid ID required) $275
Health Professional Conference Registration (Excluding MD,DO,DDS; copy of valid ID required) $180
Health Professional Virtual Registration (Excluding MD,DO,DDS; copy of valid ID required) $90
Health Professional 8th Anniversary Registration (excluding Dentists or MD/DO; copy of valid ID required) $330
Dentist or Physician Conference Registration $285
Dentist or Physician Virtual Registration $140
Dentist or Physician 8th Anniversary Registration $425
Guest Ticket for Awards Celebration Dinner $160

Purchase Succeeding in Academic Medicine

Scan of ID/Letter

If necessary, please upload a scan of your valid ID or another official letter which designates your status.

Accepted file types: pdf, Max. file size: 4 MB.

Conference registration covered by my sponsoring institution?

Click on this option ONLY if your institution is listed below. Sponsorship DOES NOT not cover payment for the Friday Awards Dinner

Sponsoring Institution

Institutional sponsorship covers conference events. It DOES NOT not include the Friday evening dinner

Name*

First Last

Email*

BNGAP username*

If you have not yet registered for BNGAP.org, please write “Not registered”

Position/Title*

Degree*

Street Address*

City*

State*

Zip Code*

Country

Phone*

Race/Ethnicity*

Select all that apply

Specify if Other

Gender Identity*

Specify if Other

Sexual Orientation*

Specify if Other

Dietary Preferences*

Specify if Other

Food Allergy?

I plan to attend conference events on the following dates:*

Check all that apply.

Your total registration fee

Please press submit to continue to Paypal to complete your registration.

$0.00

Comments

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