2026 Urology ATTENDEE REGISTRATION FORM

ATTENDEE REGISTRATION FORM
We're excited to meet at the Embassy Suites in Jonesboro, AR! The AUS Annual Meeting will take place on March 12-14, 2026.
Attendee Name*

First NameLast NameCredentials
Clinic, Company, or School Name*
Clinic, Company, or School Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Will you be bringing a guest?*

YesNo
Is your guest a physician?

YesNo
Name

First NameLast NameCredentials (if applicable)
Clinic, Company, or School Name
Clinic, Company, or School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Reservation Purposes

The event center requests an accurate food count for each break and meal event. The AUS is charged for meals for members and guests who do not show up.
Attendee
Thursday Evening Reception*

YesNo
Friday Breakfast*

YesNo
Friday Lunch*

YesNo
Friday Evening Reception*

YesNo
Saturday Breakfast*

YesNo
Guest
Thursday Evening Reception

YesNo
Friday Breakfast

YesNo
Friday Lunch

YesNo
Friday Evening Reception

YesNo
Saturday Breakfast

YesNo
Special Assistance:

If you are a person with a disability or special dietary need, please let the AUS office know so we can help make your attendance as comfortable as possible.

Questions:

For any questions regarding the event, please contact Nicole Richards at nrichards@arkmed.org or 501-224-8967.
Registration Fees
Paying by check, or by card?*

CheckCard
Please make all checks payable to: Arkansas Urologic Society

PO Box 55088

Little Rock, AR 72215
Please select all applicable option(s):

Physician Member - $275Physician Nonmember - $375Allied Health Provider - $115Spouse/Guest - $100Resident - FreeMedical Student - Free
Total
My Products
prevnext( X )
Physician Member
$275.00 Quantity



Physician Non-Member
$375.00 Quantity



Allied Health Provider
$115.00 Quantity



Spouse/Guest
$100.00 Quantity



Resident
$ Free Quantity



Student
$ Free Quantity



Total

$0.00

Should be Empty:

ATTENDEE REGISTRATION FORM

Reservation Purposes

Registration Fees