Register

The 2021 CE Sarasota Symposium is open for registration. Please use the form below to secure your spot.

Thank you for your interest in the CE Sarasota Symposium!

Registration (Individual Ticket Types)

Registration
Types of Tickets

Full Conference $350
All lectures taking place from Friday, January 10th - Sunday, January 12th. Includes complimentary cocktail hour on Friday evening, continental breakfast and lunch on Saturday, and continental breakfast on Sunday.
Sunday Only $150
Continental breakfast, Medical Errors & Jurisprudence lectures on Sunday, January 12th.
Attendees
Number of Attendees
Attendee #1
Ticket Type
Attendee Name*
First Last
Attendee Phone*
Attendee Email*
Attendee Designation*
Attendee Practice Name
Attendee's Primary State License*
Check box if your mailing address & billing address are the same.
- yes
Attendee Address*
This is where the TQ exams will be sent.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Attendee #2
Attendee #2 Ticket Type
Attendee #2 Name
Prefix First Last Suffix
Attendee #2 Phone
Attendee #2 Email
Attendee #2 Designation
Attendee #2 Practice Name
Attendee #2 Primary Licensed State
Attendee #2 Address
Street Address Address Line 2 City State ZIP Code
Attendee #3
Attendee #3 Ticket Type
Attendee #3 Name
Prefix First Last Suffix
Attendee #3 Phone
Attendee #3 Email
Attendee #3 Designation
Attendee #3 Practice Name
Attendee #3 Primary Licensed State
Attendee #3 Address
Street Address Address Line 2 City State ZIP Code
Attendee #4
Attendee #4 Ticket Type
Attendee #4 Name
Prefix First Last Suffix
Attendee #4 Phone
Attendee #4 Email
Attendee #4 Designation
Attendee #4 Practice Name
Attendee #4 Primary Licensed State
Attendee #4 Address
Street Address Address Line 2 City State ZIP Code
Attendee #5
Attendee #5 Ticket Type
Attendee #5 Name
Prefix First Last Suffix
Attendee #5 Phone
Attendee #5 Email
Attendee #5 Designation
Attendee #5 Practice Name
Attendee #5 Primary Licensed State
Attendee #5 Address
Street Address Address Line 2 City State ZIP Code
Billing Information
Coupon
Promotion
Total
$0.00
Billing Email*
What email would you like to receive billing receipt to?
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Register

Registration (Individual Ticket Types)

Registration

Attendee #1

Attendee #2

Attendee #3

Attendee #4

Attendee #5

Billing Information

About CE Sarasota

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