East by Southwest

Fourth Update in Nephrology

Registration Form

September 8 & 9, 2023

Live In-Person Activity

Inn & Spa at Loretto Santa Fe, NM


If you preregister and cannot attend please notify the office for Continuous Professional Learning in writing via email on or before August 25, 2023. No refunds will be issued after this date or for non-attendance. Activities are subject to cancelation. In the event this conference is canceled, registrants will be notified via email and will receive a full refund. CPL is not responsible for any computer/device equipment rental, airfare, hotel, car rental or other costs incurred by participants.


Prior to Starting this Form: If you are a UNM Faculty or Staff member please complete your UNM Tuition Remission paperwork (remember proper signatures are REQUIRED) you will be required to upload this document at the end of this form. https://hr.unm.edu/docs/benefits/tuition-remission-form.pdf


Please plan on completing the form in its entirety. This site cannot save your information for completion at a later date.





 

Contact Information

 
 
 
 

Ex: Gary, Dr. Smith, Gary Smith...

 

Provide all of your credentials. If medical student, list Medical Student.

 
 
 
 
 
 
 
 
 
 
Phone
 
 
 
 

Registration

 
 
 

Payment Method

 

Please select your payment method below. If you are using another payment option, please select other and explain.

 
 

Other Information

 
 

Select all that apply.

 

The conference will be providing a reception on Friday and breakfast and lunch on Saturday.


Please select all the meals you plan to attend.


Meals have been pre-ordered. We cannot guarantee there will be a meal available for registrations after September 1st, 2023.

 
 

Once you have submitted this form you will automatically directed to our TouchNet payment portal.


If you are paying with a Credit Card you MUST complete your payment in this portal. If you are not paying with a credit card your registration form is complete after you hit the submit button below and you can exit the TouchNet payment Portal you are redirected to.


*Your conference registration is not complete until we have received your payment method.

 

Click Send me a copy of my responses below for a copy of your answers and as confirmation of your submission.