2025 Annual Meeting Registration

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Name *

First

Last

Guest name(s), if applicable

Email *

Cell number

City of practice, if applicable

Primary specialty, if applicable

Copic insured?

• Yes – I am Copic insured
• No – I have medical liability insurance through another carrier
• Not applicable/not in need of Copic Points

Expected attendance at meals

• Friday evening Welcome Reception
• Saturday morning breakfast buffet
• Saturday COMPAC lunch
• Saturday evening Presidential Gala

Dietary preferences or allergies for anyone in your party:

Mobility accommodations needed for anyone in your party to fully participate in this event? (e.g., wheelchair accessibility, seating needs, elevator access):

If utilizing free childcare: Child(ren) ages:

Childcare sessions I will utilize:

• Saturday morning 8 a.m.-12 p.m.
• Saturday evening 4 p.m-8 p.m.

If participating in the Research Poster Competition: Category

• Evidence-based review
• Primary research
• Case report

Researcher name(s), primary contact listed first

Poster title and brief abstract

Comments or questions

Registration type (select all for your party) *

• Physician member of CMS – $200.00
• Physician non-member – $400.00
• Guest (adult) – $75.00
• Guest (child/ren) – $0.00
• Medical student or resident/fellow – $25.00
• Component society executive – $200.00

Total

Order Summary

Item	Quantity Qty	Total
There are no products selected.
Registration type (select all for your party) – Physician member of CMS	1	$200.00
Registration type (select all for your party) – Physician non-member	1	$400.00
Registration type (select all for your party) – Guest (adult)	1	$75.00
Registration type (select all for your party) – Guest (child/ren)	1	$0.00
Registration type (select all for your party) – Medical student or resident/fellow	1	$25.00
Registration type (select all for your party) – Component society executive	1	$200.00
Total		$0.00

$0.00

Stripe Credit Card *

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