Sponsorship Registration

For registrants who are being sponsored (for example, reduce costs for FIU trainees – medical students $30, residents $50, fellows $75) or organizations or institutions wishing to become sponsors please use the form below. You can view the Sponsorship levels.

**Please note that payment through Paypal is required and must occur at the time of registration.

Registration

Registrant's Name (First and Last name)*
Institution Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Event*
Amount*
Contact Person*
Telephone*
Email*
Advertisement
If applicable, for institutions wishing to include advertisements in the program, please attach PDF, JPG, or GIF files of the advertisement(s). (maximum number 3)
Drop files here or

Accepted file types: pdf, jpg, gif, Max. file size: 8 MB, Max. files: 3.
Total
$0.00
Name
This field is for validation purposes and should be left unchanged.

Registration

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