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 Year202320242025 First & Last name of person who will be completing payment * Enter the first & last 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. 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 Second Attendee Name * Second Attendee Email Address * Does this attendee have an account with AAAAI? * Yes No Unknown Second Attendee AAAAI Number Third Attendee Name Third Attendee Email Address Does this attendee have an account with AAAAI? Yes No Unknown Third Attendee AAAAI Number Fourth Attendee Name Fourth Attendee Email Address Does this attendee have an account with AAAAI? Yes No Unknown Fourth Attendee AAAAI Number Fifth Attendee Name Fifth Attendee Email Address Does this attendee have an account with AAAAI? Yes No Unknown Fifth Attendee AAAAI 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
