Please complete this form to initiate registration 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. Event this registration is for: * Beginning date of the event * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202220232024 Name of person who will be completing payment for office * Enter the name of the person who will log into the AAAAI system and complete payment. They will be assigned a shopping cart with all the registrations costs Email of person completing this form * Practice Name and Address * Enter the address of the practice. Physician Name * Enter the name of the physician whose practice is represented. Is the physician a member? * Please indicate if the physician is a member of the AAAAI. Yes No Physician's AAAAI member number Enter physician's AAAAI member number. If unknown, you may leave this field blank. Will the physician be attending the Workshop? * Yes No Unknown Attendee InformationEnter 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. First Attendee Name * First Attendee Email Address * Does this attendee have an account with AAAAI? * Yes No Unknown First Attendee AAAAI Number Has this attendee already registered for the Workshop? * Please indicate if this individual has registered for this year's meeting. No Yes First Attendee Order Number Please enter this attendee's order number, if known. Second Attendee Name * Second Attendee Email Address * Does this attendee have an account with AAAAI? * Yes No Unknown Second Attendee AAAAI Number Has this attendee already registered for the Workshop? * Please indicate if this individual has registered for this year's meeting. No Yes Second Attendee Order Number Please enter this attendee's order number, if known. Third Attendee Name Third Attendee Email Address Does this attendee have an account with AAAAI? Yes No Unknown Third Attendee AAAAI Number Has this attendee already registered for the Workshop? Please indicate if this individual has registered for this year's meeting. No Yes Third Attendee Order Number Please enter this attendee's order number, if known. Fourth Attendee Name Fourth Attendee Email Address Does this attendee have an account with AAAAI? Yes No Unknown Fourth Attendee AAAAI Number Has this attendee already registered for the Workshop? Please indicate if this individual has registered for this year's meeting. No Yes Fourth Attendee Order Number Please enter this attendee's order number, if known. Fifth Attendee Name Fifth Attendee Email Address Does this attendee have an account with AAAAI? Yes No Unknown Fifth Attendee AAAAI Number Has this attendee already registered for the Workshop? Please indicate if this individual has registered for this year's meeting. No Yes Fifth Attendee Order Number Please enter this attendee's order number, if known. Thank you for completing this formOnce 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. Leave this field blank
