Please complete this form to initiate registration for the Practice Management Workshop for multiple people from your practice. Please note that you will have to complete a separate online process for payment that will need to be initiated by AAAAI staff on receipt of this form.
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Enter the name of the person completing the form.
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Enter the address of the practice.
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Enter the name of the physician whose practice is represented.
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Please indicate if the physician is a member of the AAAAI.
Enter physician's AAAAI member number. If unknown, you may leave this field blank.
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Attendee Information

Enter the names and email addresses of all attendees. If the person completing this form will be an attendee, their information must also be entered below.

Email addresses must be unique to allow us to communicate with each individual.

If attendees have an account with us (i.e., they have participated in a AAAAI-sponsored activity of any kind--either live or online), please enter their member number so a duplicate account is not created. If the individual has a member number but the number is unknown to the person completing the form, please enter "Unknown" in the member number field.

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Thank you for completing this form

Once the form has been received by AAAAI staff, the person who completed it will receive an email with the registration total and a link to the online payment form.

Please note that until the payment has been received and processed attendees will not be able to register. Once payment has been received, a coupon code unique to the practice will be emailed to each attendee, along with instructions for registration. Attendees for whom new accounts are created will also receive login information. Each attendee will need to log into the system to register and select the breakout sessions he or she wishes to attend at the workshop.