|

PARTICIPANT FORM

Please use the form below to register as a participant for the Southern Sleep Society 2021 Virtual Meeting.

If you previously registered for the cancelled 2020 Conference, please do NOT register again using this form. Instead, contact the Meeting planner at mariettabibbs@southernsleepsociety.org to update your registration.

Our registration system uses PayPal for payment. Note that you can make a payment using a credit card without creating a PayPal account, if you choose to do so. Where it asks you to login to your PayPal account, just click below where it says “pay with a debit or credit card”.

For questions related to registration, please contact:
Marietta Bellamy Bibbs
mariettabibbs@southernsleepsociety.org

If you prefer to pay by check, please use our printable registration form.

Participant Info

First Name*
Last Name*
Degree/Certification
Institution
Job Title
Address*
City*
State/Province
Zip/Postal Code*
Country
Work Phone
Cell Phone*
Fax
Email Address*

Registration Options

Dues payments are not refundable and will not count towards any refunds or remaining registration fees to be used at the 2021 in-person conference. No refunds for new registrations after 4/10/2021.

Registration Type* Before
4/9/2021		 After
4/9/2021		 Line Amount
$75.00 $100.00
$100.00 $125.00
$150.00 $175.00
$40.00 $40.00
Processing Fee
Total

Sleep Medicine Jeopardy

Will you participate in Sleep Medicine Jeopardy?*