The Journal of the Arkansas Medical Society Issue 10 Vol. 114 | Page 10

2018 Annual Meeting Registration Form
142 nd AMS Annual Session | May 4-5, 2018| DeGray Lake Resort State Park | Bismarck, Ark.
Registrations made by credit card may be faxed to 501-224-6489. If you have any questions, please call 501-224-8967 or 800-542-
1058. Refunds requested prior to April 27, 2018, will be at the full amount. Refunds requested after that date will be charged a $25
processing fee. All refunds will be mailed after the convention. You can register online at www.ArkMed.org.
Section 1: Registrant Information
Member Name: ___________________________________________________________________________________________
Spouse or Guest Name: ____________________________________________________________________________________
Address: ________________________________________________________________________________________________
City: _______________________________________________________________ State: ______ Zip: _____________________
Phone: ____________________________________________ Fax: __________________________________________________
Email:___________________________________________________________________________________________________
Section 2: Registration
AMS Physician Members or their Staff:
Registration Fee
$135 Per Person
Physician Non-Members or their Staff:
Registration Fee
$235 Per Person
Attending House of Delegates Meeting ONLY:
(No Charge)
Please help us make an accurate meal order by indicating the
number of people who will attend the following:
Spouse or Guest:
Registration Fee
$ 65 Per Person
____________ Welcome Reception (Friday)
____________ Inaugural Gala (Friday)
Medical Student and Resident Members or their Guests:
Registration Fee
$ 15 Per Person
Total Registrati