Our Hosts Srikar Adhikari Josie Acuña Rich Amini Elaine Situ-LaCasse Membership InformationThank you for being a SCUF member! Please purchase your discount conference registration on this form.You can obtain discounted registration by becoming a SCUF member. If you are a member please login here and refresh this page. If you are not a member but would like to become one you can register on this page.Contact InformationName* First Last Email* Cellphone NumberTwitter HandleProfessional InformationWould you like a year of SCUF membership with your registration?*A year of membership is FREE with registration. The cost is usually $50, but a benefit of membership is reduced priced registration to our annual conference. We will apply this discount and therefore purchasing membership today will cost you nothing.YesNoHospital/Program Affiliation*Title (select all that apply)*ResidentStudentAPPFellowUltrasound FacultyUltrasound Fellowship DirectorUltrasound Section/Division ChiefInstitution-wide Ultrasound DirectorOtherIf other title please clarify*Your Hospital/Program Location State Post Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Fellowship Status*Never completed fellowshipFormer fellowCurrent fellowFellowship Program*Fellowship Start Date MM DD YYYY Fellowship Graduation Date* MM DD YYYY Fellowship Graduation YearProgram Director E-Mail*Enter the e-mail address of your program director so we can verify your fellowship status. Degree TypeMDDONPPAotherWhat are your specialties?*Emergency MedicineInternal MedicineCritical CarePediatricsPediatric Emergency MedicineFamily MedicineOther/NonePaymentConference Registration Price: $250.00 Purchase registration, but do not sign up for membership.Conference Registration and 1 Year SCUF Membership Price: $250.00 Member Conference Registration Price: $200.00 Thank you for being a SCUF Member! This price includes your discount.Non-member Fellow Registration Price: $150.00 Register for conference but not SCUF membership.Non-member Fellow Registration and Membership Enrollment Price: $100.00 As a fellow you are entitled to 2 years of free SCUF membership from the start of your fellowship. After that membership will be $50 a year. This will not automatically renew, we will ask if you wish to continue your membership when it expires.Member Fellow Registration Price: $100.00 Thank you for being a SCUF Member! This price includes your membership discount.Student/Resident/APP Registration Price: $150.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Total $0.00
Srikar Adhikari
Josie Acuña
Rich Amini
Elaine Situ-LaCasse
