Osteopathic Foundation of West Michigan
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WMOA 2023 Bonus Interface
December 12, 2023
Contact Information
Name
*
First Name
Last Name
AOA#:
Email:
*
Verify Email
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Plans to attend:
Please RSVP for your in-person attendance. Please note that Non-Member fees will be applied for those without an active 2023 membership.
Yes, I will be in attendance.
Professional Level:
select one
Physician - DO
Physician - MD
DO - Physician in Training - Family Medicine
DO - Physician in Training - Internal Medicine
DO - Physician in Training - Emergency Medicine
DO - Physician in Training - OB/Gyn
Physician in Training - Medical Student
Physician Assistant - Resident
Physician Assistant
Nurse Practitioner
Other
Non-Member?
Non-members are charged a $50 fee for monthly CME Events.
Payment will be provided at the registration table.
Request an invoice.
Meal request:
*
Please select if you would like a meal for the evening.
Yes, please reserve a dinner option for me.
Yes, please reserve a vegetarian dinner for me.
No, I will be in attendance, however, I do not need a dinner option.