DirectionsPlease complete this form to initiate registration for multiple people from your practice. 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. First & Last name of individual completing payment * Enter the first & last name of the person who will complete payment. They will be assigned a shopping cart with all the registrations costs and MUST HAVE AN AAAAI ACCOUNT (both member and guest accounts will work) Email address of individual completing payment. * Practice/Organization Name and Address * Registrant InformationEnter the names and email addresses of all registrants. If the person completing this form or completing payment also needs to register for this course, 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. Does this individual have an account with AAAAI? * The user will need to have an AAAAI Account to access the course (they do not need to be a member of the AAAAI) Yes No Unknown First registrant - first name, middle initial & last name * First registrant email address * What price level do you want to register this individual at? * $250 - AAAAI FIT Member $350 - AAAAI Physician Member $450 - Non-Member (FIT or Physician) First registrant AAAAI Member number Does this individual have an account with AAAAI? * The user will need to have an AAAAI Account to access the course (they do not need to be a member of the AAAAI) Yes No Unknown Second registrant - first name, middle initial & last name * Second registrant email address * What price level do you want to register this individual at? * $250 - AAAAI FIT Member $350 - AAAAI Physician Member $450 - Non-Member (FIT or Physician) Second registrant AAAAI Member number Does this individual have an account with AAAAI? The user will need to have an AAAAI account to access the course (they do not need to be a member of the AAAAI) Yes No Unknown Third registrant - first name, middle initial & last name Third registrant email address What price level do you want to register this individual at? * $250 - AAAAI FIT Member $350 - AAAAI Physician Member $450 - Non-Member (FIT or Physician) Third registrant AAAAI Member number Does this individual have an account with AAAAI? The user will need to have an AAAAI Account to access the course (they do not need to be a member of the AAAAI) Yes No Unknown Fourth registrant - first name, middle initial & last name Fourth registrant email address What price level do you want to register this individual at? * $250 - AAAAI FIT Member $350 - AAAAI Physician Member $450 - Non-Member (FIT or Physician) Fourth registrant AAAAI Member number Does this individual have an account with AAAAI? The user will need to have an AAAAI Account to access the course (they do not need to be a member of the AAAAI) Yes No Unknown Fifth registrant - first name, middle initial & last name Fifth registrant email address What price level do you want to register this individual at? * $250 - AAAAI FIT Member $350 - AAAAI Physician Member $450 - Non-Member (FIT or Physician) Fifth registrant AAAAI Member number Sixth registrant - first name, middle initial & last name Sixth registrant email address What price level do you want to register this individual at? * $250 - AAAAI FIT Member $350 - AAAAI Physician Member $450 - Non-Member (FIT or Physician) Does this attendee have an account with AAAAI? Yes No Unknown Sixth registrant AAAAI Member number Does this individual have an account with AAAAI? The user will need to have an AAAAI Account to access the course (they do not need to be a member of the AAAAI) Yes No Unknown Seventh registrant - first name, middle initial & last name Seventh registrant email address What price level do you want to register this individual at? * $250 - AAAAI FIT Member $350 - AAAAI Physician Member $450 - Non-Member (FIT or Physician) Seventh registrant AAAAI Member number Does this individual have an account with AAAAI? The user will need to have an AAAAI Account to access the course (they do not need to be a member of the AAAAI) Yes No Unknown Eighth registrant - first name, middle initial & last name Eighth registrant email address What price level do you want to register this individual at? * $250 - AAAAI FIT Member $350 - AAAAI Physician Member $450 - Non-Member (FIT or Physician) Eighth registrant AAAAI Member number Thank you for completing this formOnce the form has been received by AAAAI staff, the person listed as completing payment will receive an email with the link to complete the online payment.Please note that until the payment has been received and processed attendees will not be registered. Once payment has been received, the individuals listed above will be registered for the event and sent a separate email with information regarding access. Leave this field blank
