Skip to content
Login
Login
CSOEMA
Central States Occupational and Environmental Medicine Association
Home
About
Seminar Details
Awards
Contact
News
Jobs
Shop
Menu
Home
About
Seminar Details
Awards
Contact
News
Jobs
Shop
Register for the Fall Seminar
Exhibitor Info & Registration
Spring 2025 Seminar Registration Page
Contact Information
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Mailing Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Seminar Attendee Details
Which portion(s) of the seminar will you be attending?
(Required)
Thursday Only
Friday & Saturday
Thursday, Friday, & Saturday
Single Day Session
Will you be attending online or in-person?
(Required)
Note: Both the Virtual and Live Event are the same price.
I will attend in person
I will attend virtually (online)
Are you a student or resident?
(Required)
Chose only one selection.
No, I am neither a student or resident
Yes, I am a student
Yes, I am a resident
Are you an ACOEM Fellow or Past CSOEMA President?
(Required)
Yes
No
Are you an ACOEM Fellow or Past CSOEMA President?
(Required)
Please select all that apply.
ACOEM Fellow
Past CSOEMA Presidente
ACOEM Membership Status
(Required)
Please select your current ACOEM membership status. Associate attendees are Physician Assistant, Nurse Practitioner, or a certified Occupational Health Nurse (COHN) ** Note - Due to technical issues with the registration form, Associate members may not be charged for their registration. If that occurs, you will be contacted for payment. Thank you for your patience.
Not a Member
Member
Retired Member
Associate Attendee
ACOEM ID
Please enter your four to six digit ACOEM ID number below to receive the member price for this seminar.
Badge Information
How would you like your first name to appear on your badge?
(Required)
Degree(s) & Title(s)
(Required)
This information will appear on your printed badge under your name.
Organization Information
This information will appear on your printed badge under your name and titles (i.e. School, Practice, Hospital, Company) (optional)
Registration Details
CSOEMA 2025 Spring Seminar Registration Fee
CSOEMA 2025 Spring Seminar Registration Fee:
$0.00
Early Bird Discount
$50 Discount if you register before January 1, 2025.
$0.00
Total
Refund Policy
(Required)
Registrants canceling more than 10 calendar days before the seminar may receive a refund (less a $25 cancellation fee). Registrants canceling within 10 calendar days of the seminar are not eligible to receive a refund. Cancellations due to extenuating circumstances will be reviewed on a case-by-case basis and are subject to $25 cancellation fee.
I agree to the cancellation and refund policy.
Unique Verification Code
Payment Method
