Website Registration for Sponsors, Exhibitors, and Advertisers

- Please confirm that you would like to register for a website account as a Sponsor, Exhibitor, or Advertiser.*
  - Yes
  - No
- Login Details
- Username* This cannot be changed once created. (Required)
- Password*
  The password must have a minimum strength of MediumStrength indicator
- Repeat Password*
- Institution Details
- Institution Type* Above, please select the type of institution you are representing. Choose the most applicable option. (Required)
- Institution* Please indicate the school or organization you are currently affiliated with. If None, please write "None" above. (Required)
- Institution City* Please provide the city in which your institution is located. (Required)
- Institution State* Please provide the state in which your institution is located. Select "NA" if your institution is outside of the U.S. and its territories. (Required)
- LMSA Region* Please select the LMSA region in which you or your institution are located. (Required)
- Instructions for Medical Specialties Field
  For the field below:
  - - Medical and premedical students: please indicate the medical specialty or specialties you are interested in pursuing.
  - - Healthcare professionals, please indicate your area(s) of practice.
  - - Sponsors, exhibitors, and advertisers, please choose the field(s) you represent. If you are representing a college or medical school, please choose "Not Applicable (N/A)."
  - - For all other individuals, please select "Not Applicable (N/A)."
  You may choose multiple options. (Required)
- Medical Specialties*
  - Not Applicable (N/A)
  - Undecided
  - Anesthesiology
  - Child Neurology
  - Dermatology
  - Emergency Medicine
  - Family Medicine
  - Internal Medicine
  - Medicine-Pediatrics
  - Neurological Surgery
  - Neurology
  - Nuclear Medicine
  - Obstetrics & Gynecology
  - Orthopaedic Surgery
  - Osteopathic Neuromusculoskeletal Medicine
  - Otolaryngology - Head and Neck Surgery (ENT)
  - Pathology (Anatomic/Clinical)
  - Pediatrics
  - Physical Medicine & Rehabilitation
  - Plastic Surgery
  - Preventive Medicine
  - Psychiatry
  - Radiation Oncology
  - Radiology (Diagnostic and/or Interventional)
  - Surgery (General)
  - Thoracic Surgery
  - Urology
  - Vascular Surgery
  - Other/Not Listed
- Name
- Prefix/Title Please indicted your preferred prefix, title, or honorific above, such as Dr., Mx., etc. (Optional)
- First Name* Please provide your first name(s) above. You may also include middle names here. (Required)
- Last Name* Please provide your last name, also known as surname or family name. (Required)
- Suffix Please indicate "Jr., III, IV," etc. here, along with terminal degrees. (Optional)
- Nickname If you would prefer to use another name, please indicate so here. (Optional)
- Pronouns *
- Pronouns* Please let us know which pronouns to use to best address you. You may choose one or more of the provided options below, or write in your own. If writing in pronouns, we ask that you first select "Not Listed Here" and then specify your pronouns. If you would prefer not to answer this question, please input "Prefer not to answer." (Required)
- Contact Information
- Email Address* Please provide your preferred email address above. This may be changed in your profile at any time. (Required)
- Phone - Country Code Please enter "1" if you have a US phone numnber.
- Phone* Required phone number format: (###) ###-####
- Email & Phone Usage*
  - I acknowledge and accept the Email & Phone Usage terms.
  Your contact information will not be published or made public. By proceeding with this registration, you acknowledge that LMSA may contact you by email and SMS text messaging and allow LMSA to do so. You may opt out of email communications at any time by selecting the appropriate option in any LMSA email or out of text messaging by sending STOP to 872-813-5672.
- Join our mailing list?
- Professional Information
- Professional Category* Please select the professional category option above that best applies to you. (Required)
- Professional Title*
- LMSA Chapter Affiliation*
  - Yes
  - No
  - Unsure
  - Other
  Are you affiliated with any LMSA or LMSA PLUS Chapter?
- Are you the chapter advisor at your institution?*
  - Yes
  - No
  - Not Applicable (N/A)
- Alumni Status*
  - Yes
  - No
  - Unsure or Other
  Are you an alumnus/a of LMSA or any of its antecedent organizations? (e.g. NNLAMS, BHO/NBLHO, CMSA, LMMSA, TALAMS, HAMSA, etc.)?
- Where did you attend school while you were a part of LMSA or its antecedent organizations?
- In what year did you graduate?
- Additional Information
- How did you hear about LMSA?
  - Local chapter
  - Current member
  - Alumnus/a
  - School administrator
  - Email from LMSA
  - LMSA Newsletter
  - LMSA Website
  - Search Engine
  - Other
- Accommodations Please let us know if you require any form of assistance or special accommodations to participate in LMSA programming.
- - Billing Address
  - Country*
  - First Name*
  - Last Name*
  - Company Name
  - Address*
  - Town / City*
  - State / County*
  - Postcode / Zip*
  - Email Address (for billing and receipts)*
  - Ship to a different address?
- Confirm Information*
  - Yes
  Please review the information you have entered in each tab for accuracy and completeness. Once you have done so, please select Yes, I confirm above and click Register below.

Login Details

Institution Details

Instructions for Medical Specialties Field

Name

Pronouns *

Contact Information

Professional Information

Additional Information

Billing Address