2019 Conference Registration 123456 Site/Client ID*Select IDACHACMAKRONALASKAMDLARCHBARHSATHENATLANAULTMAWMGSBAPMSBARROBAYLOBDCHBETHEBHMCBHSBIDMCBILOXBLOUNBRKVLCABELCAMCCAPITCARLECARLICARSOCATHOCCHCCHSCFHISCFNICGHCHARLCHIAKCHILTCHMCCHOCHOMPCHOPCHURCLARKCLSHCMCNHCMMCCOFFECONEMCONWICOOKCOOLECOOPECOPLECOVANCPACRAWCRMCCTRXDALLADAMASDAVISDCHSDEKALELCAMELCENEMHEVANSFAIRFFENTRFLEURFRESNFRISBGBMEDGENOPGENOVGENZYGHCGHSGILMOGUNDEGUTHRHAMILHANNIHARDIHARRHARTOHARVAHCORHEARTHENDRHFIRSHILMCHISEBHMCNJHOLLAHOLYCHOLZHSCHUTCHHVCHIMCINGALINOVAIREDJHHSJOINTJPSJTRONKENNEKINDRKINGSKNOXKPNCKRMCKSBHLABCPLAHEYLAKENLANCALCMCHLEXINLIBERLIFESLNSPLOWERLRMCMAIMOMAINEMAYOMEDISMERCYMERMDMETHOMHLANMHUCMIDWEMIHSMILWAMMHMMHSMOBILMONROMONTEMOUNTMSHAMTSINMTSNYMUNROMVHMWHCNACOGNAPLENCHNEMONEWLINHNCNIHNJHNORTHNPLNWMEDNWMISNWTOAKLAOCHSNOKLAHOLMORMCOSUWMPALISPARKNPARKVPASCOPASSAPATHWPAULBPECONPHCOSPHMIPHSTMPHYSIPIEDMPIKEVPMHDPPDRANKIRCMRCRHREGINRENOWRGHRIVEWRIVOARUMCRWJUHSAMHSSANDSASKASATELSBROWSCOTTSCPMGSEBASSEVENSFMCSHNCYSHNFHSHNHRSHINSHNKTSHNMCSHNPASHNPNSHNSCSHNSRSHORESJHSSLHSSLIDESLUSMDCSNEWHSOMCSPARRSPRHSSRHSSROSASSHSSTANTSTCLOSTFRHSTJFLSTMICSTMWVSTORMSTPETSTRITSTRNGSTRONSTROSSUMMASWEDITAHOETAOSTECTHEDATHPGTHREETJUHTMHSTMLTORONTOUROTRNTYTUFTSTUHSTWINUCMCUCONNUCSDUHEALUHHSUHSUMCUMCEPUMHUMICHUNDERUNIHSUNMCURHCSUSLABUWIVANCOVANDEVCHSVENICVHCVIRTUWAKEMWALTOWARREWATSOWBHWCAWELLSWENTWWESTCWFBMCWILLWMCWUESTWVMCYAKIMYNHHFacility Name* Attendee Name* First Last Attendee Title* Please enter your job titleAttendee Job Category*Please IndicateManagementLIS ApplicationsIT SupportPathology-GeneticsLaboratory ScientistSCCPlease indicate your role typeAttendee Work Address* Street Address City State / Province / Region ZIP / Postal Code Country*United StatesCanadaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweAttendee PhoneAttendee Email Are you the primary contact for SNUG from your facility?* Yes No If you are not the primary contact person, who is? HiddenIs your site a current member of SNUG? - Site must be PAID member for discounted rate Yes No We couldn't verify your membership, please contact us to confirm your membership. Conference Registration Fee — Per Person*Full — $11001-Day — $2752-Day — $550Conference Registration Fee — Per Person*Full — $4251-Day — $1752-Day — $325If registering for one or two days, please indicate which ones Monday Tuesday Wednesday Thursday HiddenSNUG Swag - Shirt Size - Must Register by DeadlineNo Shirt 2020No Shirt RequestedShirt Only - No SwagSwag Only - No ShirtWomen's SmallWomen's MediumWomen's LargeWomen's XLWomen's XXLWomen's XXXLMen's SmallMen's MediumMen's LargeMen's XLMen's XXLMen's XXXLIf you want a shirt only with no additional promotional items, please choose the Shirt Only No Swag and indicate your shirt size in the Special Needs Comment Box. If you want promotional items but no shirt, choose Swag Only - No Shirt optionDo you plan on attending the Pre-Conference Workshop*Please SelectYesNoWorkshop will be held Sunday, May 3 from 1pm to 5pm*****Receptions and Banquet***** Please indicate whether you will be attending each.Welcome Reception — Sunday, May 3*Please SelectYesNoVendor Reception — Tuesday, May 5*Please SelectYesNoSCC Sponsored Sunset Dinner Cruise (Free) — Wed, May 6*Please SelectYesNoAdditional Banquet Guest(s)*01234Banquet Guest Name(s)Guest 1 Guest 2 Guest 3 Guest 4 Do you plan on attending the Workshop - Monday - Wednesday, May 4 -6*Please SelectYesNoThe workshop is 12 hours total divided into three 4 hours sessions Monday – Wednesday*****Attendee and Guest Daily Lunch*****Free Daily Attendee Lunch*Please SelectYesNo Mon Tue Wed Thu Additional Lunch Guests ($20 per guest/per day)*01234Lunch Guest 1 Days Mon Tue Wed Thu Number of DaysLunch Guest 2 Days Mon Tue Wed Thu Number of DaysLunch Guest 3 Days Mon Tue Wed Thu Number of DaysLunch Guest 4 Days Mon Tue Wed Thu Number of DaysLunch Guest Fees:* Price: $0.00 Lunch Guest Fees: Is this your first time attending SNUG Conference?*Please SelectYesNoIf yes, will you attend Monday morning welcome breakfast?*NoYesHave you served on the SNUG Board?*Please SelectYesNoWhat is the name of your HISOtherEpicCernerMcKessonAllScriptsSiemensOtherAre you interested in presenting at a session? (Note: incentives provided)*Please SelectYesNoIf yes, what is session topic? Will you be staying at the conference hotel?Please SelectYesNoIf no, reason? (cost/other arrangements/share hotel) Emergency Contact Info: Indicate any special needs (e.g. dietary):Lunch Guest Fees:Conference Fee:Payment Options* Pay By CC Pay By Check *** Please note that if choosing to pay via credit card, you must be ready to pay now in order to complete the membership registration.Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Remember, your registration is not complete until payment is received. Payment instructions will be available on confirmation page. For questions, please contact SNUG President, Steve Pleschourt at 507-284-2923 or pleschourt.steven@mayo.edu. Conference Cancellation Clause: Cancel with no penalty on or before Friday, April 5, 2019. Full fees will be charged for cancellations received after Friday, April 5 2019 and the conference. Cancellations must be received in writing. Any course is subject to cancellation by SNUG, Inc. Conference Disclaimer: SNUG, Inc. claims no liability for the acts of any supplier at this meeting or for the safety of any attendee while in transit to, from, or during this meeting. Attendees who purchase non-refundable airline tickets do so at their own risk. SNUG reserves the right to cancel this function without penalty. Total amount of liability to SNUG will be limited to a refund of fees paid by attendee less processing fees. Privacy Statement: SNUG will only share your information with fellow SNUG members, the SNUG Registrar, SCC employees and SNUG Conference Sponsors. If you do not wish to share your information, please contact our registrar at snug@thelinkevents.com. Invoice Info Name Job Category Facility Name Address Email Phone Charges Conference Fee Lunch Guests Total CAPTCHA - Enter the Value