2026 Conference Registration Form

Conference Registration Form

Welcome to the registration for the 6th Annual Saifee Burhani medical Association Conference!
Conference Program
ITS Number

Please enter your ITS number in the field provided, and click the "LOOKUP ITS NUMBER" button. If you have registered with the SBMAA Directory, we can pre-fill some of your information. Please be sure to click the Lookup button even if you have not registered.
Enter your ITS Number
ITS Number
Personal Information

Your full name and credentials will be printed on your conference badge, so please ensure that these are accurate.
Title
(If Applicable)
First Name
Last Name
Professional Credentials
Acronyms only. Please use ALL CAPS, NO periods. If multiple, use commas to separate. Examples: Degrees such as MD, DO, PHD, DDS, RN, PA, NP, PHARMD, etc. Certifications such as FAAD, FACOG, OTR, RDMS, FACP, ABOM, etc. Students/trainees should leave this blank.
Employment Status

Other
Have you attended any previous SBMAA conferences?
Thank you for joining us!

First-time attendees receive $53 off the registration fees (not applicable to student rate). This discount will be reflected below in the total fees.
Welcome back to SBMAA!

Your conference badge will reflect your "SBMAA Veteran" status - Thank you for your support!
Please select all the previous conferences you have attended
On behalf of your local jamaat Umoor Sehat committee, do you have a jamaat health initiative that you would like to present during the Umoor Sehat session? We will contact you for more details.
Students and Trainees

A student is defined as an individual who is currently enrolled in undergraduate study, has graduated from an undergraduate program, and/or is enrolled in an accredited training program for a medical or health-related profession. Examples include undergraduate students, graduate students, medical students, residents, and clinical trainees. Fellows and other practicing professionals are not considered students.To verify student status, applicants may upload documentation such as proof of current enrollment, a student identification card, an ECFMG Certificate, a medical diploma or license, USMLE documentation, or other documentation confirming their current student or trainee status.
Student ID

Please upload a copy of your student or trainee identification. If your identification is not valid, then your registration may be canceled unless you pay the full conference registration fee. File types accepted: PDF, JPG, PNG only
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Professional Field and Specialization

The following categories and specializations are a Health Care Provider Taxonomy defined by the National Uniform Claim Committee (NUCC). The taxonomy codes are organized based on education and training and are used to define specialty, not specific services that are rendered.
Primary Specialty
Please select your primary specialty from the drop-down. If you are a student, select your field of study/focus or anticipated career.
Allopathic & Osteopathic Specialties

Other
Behavioral Health & Social Service Specialties

Other
Chiropractic Specialties

Other
SBMAA Dental Symposium

The Dental Symposium at SBMAA will be dedicated sessions of benefit and interest to all practicing dental professionals! More information to follow after registration.
Dental Specialties

Other
Dietary & Nutritional Service Specialties

Other
Emergency Medical Service Specialties

Other
Eye and Vision Services Specialties

Other
Nursing Service Specialties

Other
Nursing Service Related Specialties

Other
SBMAA Pharmacy Symposium

The Pharmacy Symposium at SBMAA will be dedicated sessions of benefit and interest to all practicing pharmacy professionals! More information to follow after registration.
Pharmacy Service Specialties

Other
Physician Assistants & Advanced Practice Nursing Specialties

Other
Podiatric Medicine & Surgery Service Specialties

Other
Public Health and Population Service Providers
Respiratory, Developmental, Rehabilitative and Restorative Service Specialties

Other
Speech, Language and Hearing Service Specialties

Other
Technologists, Technicians & Other Technical Service Specialties

Other
Alternative Medicine Specialties

Other
Other Service Specialties

Other
Contact Information

This information will be embedded on your badge as a QR code so that you can share your contacts with other colleagues.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
City of Residence
Please enter the city where you reside and/or practice.
State or Province of Residence
Jamaat Affiliation
Country of Residence

Other
Accomodation
Wellness Sessions

SBMAA will offer a variety of physical and mental wellness activities for conference attendees throughout the weekend. On Friday, personal wellness sessions, including massage, cupping, and other services, will be available by appointment, with a sign-up sheet to follow.Friday afternoon will also include sports and recreational activities from 4:30 p.m. to 6:30 p.m., including pickleball, tennis, badminton, volleyball, table tennis, cornhole, and potentially kickboxing. Some outdoor activities will be weather permitting, and separate time slots may be offered for men and women.All wellness and sports activities will be based on provider availability, attendee interest, and minimum sign-up numbers.
Wellness sessions
Darees at Masjid ul Zainee

Please RSVP for Darees on Friday, Oct 9th at 7:00 pm at Masjid ul Zainee in New Brunswick, NJ.
Darees RSVP
Number of Attendees
Please specify how many people (adults and children) from your family/group, including yourself, will attend the Darees. This will help us plan for thaal count.
Academic Abstract & Poster Session

Ideal showcase for your academic excellence! Abstracts will be peer-reviewed for poster presentation, and the top 3 abstracts will be selected for oral presentations. Artists may also upload artwork for display.
Abstract Submission Deadline: September 1st, 2026
Please upload your poster abstract as a PDF

Your PDF should include: 1. Title, 2. Authors, 3. Institutions, 4. Introduction, 5. Objectives, 6. Methods, 7. Results, 8. Discussion, and 9. Summary. Abstracts should be a maximum of 300 words and may include no more than 1 table or figure within the PDF. The submission deadline is September 1, 2026. If your PDF is not ready at the time of registration, please email to BKAJCARBAIDWALA@LURIECHILDRENS.ORG with subject line: "2026 SBMAA Conference Poster Abstract Submission"
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Khidmat Shark Tank Competition

Get ready to unleash your imagination at the 2nd annual SBMAA Shark Tank Showdown! Moula TUS emphasized that we should strive towards khidmat opportunities. So let’s heed Moula’s call to khidmat! We’re looking for individuals or teams to propose bold, innovative ideas that will uplift our jamaats through impactful medical initiatives. A Grand Prize of $5,000 in funding awaits the first-place team to kickstart your initiative! The initiative must be unique and reproducible in other jamaats in North America. Let’s dive in, dominate the tank, and secure the funding to start changing lives!
I would like to participate in the Khidmat Shark Tank! (Details to follow)
Networking Session Leadership Interest

During the conference, there will be dedicated networking time for attendees to connect informally. This is open time for anyone who would like to gather with others around a shared topic, specialty, career interest, or community health idea. These sessions are meant to encourage conversation, collaboration, and new connections among attendees.
I am interested in leading or facilitating a small networking discussion during the conference? (Details to follow)
New York City Outing

Join fellow attendees for an optional Sunday afternoon outing to New York City and downtown Manhattan. This will be a relaxed opportunity to spend time together, explore the city, and enjoy the final day of the conference weekend. Additional details will be shared closer to the conference.
I will attend the outing on Sunday afternoon to New York City
Please let us know if you have any special needs (wheelchair, etc.)
Guests attending the Saturday night Dinner
Specify any additional guests, not including yourself, who will attend the Saturday night dinner. Additional guests are $110 each and will receive a guest badge and dinner ticket. All guests attending the Saturday night dinner must have a paid ticket.
Registration Fee Payment

Online registration will close Oct. 2, 2026.
Guest Fees
Base Registration Fee
Fees are $553 for physicians and dentists, $453 for non-physicians, and $253 for trainees.
First Time Discount
Early Bird Discount
Registration on or before August 15th, 2026, to get an early bird discount of 15% off registration. Only applies to base registration fee, not guest fees.
Priority Member Discount
Dues-paying SBMAA members get additional discounts on registration: Supporters 15%, Patrons 50%, and Fellows free registration. For more information on priority membership costs and benefits, please email info@sbmedical.org
Total Registration Fee

Payment Amount

USDPlease enter the total from "Total Registration Fee" here. Refund Policy: Cancellations received on or before September 15, 2026 are eligible for a full refund. Cancellations received after September 15 and on or before September 30, 2026 are eligible for a 50% refund. No refunds will be issued after September 30, 2026.

Credit Card

Administrative Code
For use by SBMAA Officers and Staff ONLY. Others should LEAVE THIS FIELD BLANK or you will not be able to submit the form.
Badge
If you are using an admin code, please specify your badge category using the drop down.
Should be Empty:

Conference Registration Form

ITS Number

Personal Information

Thank you for joining us!

Welcome back to SBMAA!

Students and Trainees

Professional Field and Specialization

SBMAA Dental Symposium

SBMAA Pharmacy Symposium

Contact Information

Wellness Sessions

Darees at Masjid ul Zainee

Academic Abstract & Poster Session

Khidmat Shark Tank Competition

Networking Session Leadership Interest

New York City Outing

Registration Fee Payment

Payment Amount

Credit Card