VEITHsymposium Registration

TUESDAY, NOVEMBER 13 - SATURDAY, NOVEMBER 17, 2018 | New York City

Connecting The Vascular Community

First Name: _________________________________ Last Name (Surname, Family Name): __________________________ Degree: ____________

Physician Non-Physician Cleveland Clinic Employee? Yes No Specialty: ___________________________________

___________________________________________________________________________________________________________________

Address Type: Home Other Address: _____________________________________________________________________________

City: ______________________________ State/Province: _________ Zip/Postal Code: ___________________ Country: ____________________

E-mail: __________________________________________________ (A valid registrant’s

Alternate E-mail: _______________________________________________________ (contact person)

Phone: _________________________________________________________________________ Fax: ______________________________________

New York Hilton - Midtown1335 Avenue of the AmericasNew York, New York 10019

Full Registration (Tuesday - Saturday) Tuition includes access to all Saturday Only Components. Tuition*

Physicians (excluding Fellows/Trainees and Residents) $1399

Physicians Combination Rate - VEITHsymposium and AVIDsymposium $1899

Physicians Combination Rate - VEITHsymposium and AIMsymposium $1899

Physicians Combination Rate - VEITHsymposium, AIMsymposium and AVIDsymposium $1899

US 2nd-Year Fellows in an RRC-approved 2-Year Vascular Fellowship OR 5th-Year Vascular Resident in an approved ComplimentaryVascular Surgery Residency as of November 2018, AND Canadian Vascular Surgery Fellows in Training (Tuition is provided through an Educational Grant by W.L. Gore & Associates Inc.) Letter of verification on official hospital stationery must be obtained prior to registration and faxed to (888) 418-7043. The letter must include the start and end date of vascular fellowship.

$699

Physician Assistants (non-physician,clinician) Nurse Practitioners $699

Residents Nurses Technologists $650

$500

Associate Faculty Global Podium Presentations Program (AFGPP): If you are submitting to the AFGPP Program, please contact the Registrar at registrar@veithsymposium.org for registration fee.

Allied Health Care Professionals, Venture Capitalists, and All Others $950

Non-US Fellows and Residents (Trainees)

I will attend the Chimney EVAR Workshop Wednesday, November 14, 2018. Time and Location TBD (This is a Non-CME Activity, limited to 35 fully paid VEITHsymposium registered Physicians, excluding Fellows/Residents.) Complimentary

I will attend the Venous Venous Venous WorkshopThursday, November 15, 2018, 2:15pm-6:15pm, Americas Hall 2, 3rd Floor (Registration is limited to 125 fully paid VEITHsymposium registrants.)

Not registering Registered Clinicians (Non-industry): $25 Registered Industry, Including Exhibitors: $100

$25 or $100

VEITHsymposium RegistrationConnecting The Vascular Community

New York Hilton - Midtown1335 Avenue of the AmericasNew York, New York 10019

PAYMENT METHOD

Check Please make checks payable to the Cleveland Clinic Educational Foundation and mail to: The Cleveland Clinic Educational FoundationAttn: 02010959P.O. Box 931653Cleveland, OH 44193-1082

If paying by courier such as Federal Express, UPS or DHL, send check to:The Cleveland Clinic Educational FoundationAttn: Lockbox 9316534100 West 150th StreetCleveland, OH 44135Checks must be received by October 31, 2018. Please include a copy of this registration form with your payment.

Name on Card: _______________________________________________________________________________ Amex MC VISA

Credit Card Number: _______________________________________ Verification Code (3-or 4-digit security code located on your card): _________

Expiration Date: ____________________________________________________ Signature: ________________________________________________

Credit Card

FRIDAY ONLY COMPONENT MEETING

Innovation & Investment Summit $349 Friday, November 16, 2018, 7:45 a.m. to 11:55 a.m. Location TBD

(This is a Non-CME Activity. Registration fee is complimentary for fully paid VEITHsymposium Registrants, including Fellows and Industry Personnel.)

VEITHsymposium JOB FAIR Thursday, November 15, 2018, 8:00 a.m. to 4:00 p.m., Americas Hall 1, 3rd Floor (This is a Non-CME Activity.)

P Potential Employer/RecruiterFor Employers/Recruiters not registered at VEITHsymposiumTuition includes access to VEITHsymposium Friday sessions only (excluding the Innovation and Investment Summit).

If you are a VEITHsymposium registrant you have complimentary access to the JOB FAIR: I will not be attending the JOB FAIR I am a Potential Employer/Recruiter who is already registered for VEITHsymposium I am a Graduating Fellow/Attending Seeking New Opportunity

$500

SATURDAY ONLY COMPONENTS VEITHsymposium (Miscellaneous Topics) Hemodialysis Access (Physicians only)

Hemodialysis Access (Non-physician, clinician only [not available to industry personnel])

Tuition includes access to any Saturday Only Component.

Tuition includes access to Hemodialysis Access Only.

Tuition includes access to any Saturday Only Component. $349$349

$150

Cancellation Policy: There is a $95 cancellation fee if canceled in writing by October 12, 2018. No refunds will be made thereafter.

Tuition*