2022 SPARTAN Annual Meeting Registration NameThis field is for validation purposes and should be left unchanged.Name* First Last Professional DesignationsMDMBBSMScPharmDPhDNPMPHMBAPAOtherTitle:*Organization or Academic Institution:*Email:* Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country I am a:* SPARTAN Full Member SPARTAN Associate Member SPARTAN Trainee Member Nonmember: Trainee, North America Nonmember: Advanced Practice Provider (PA, NP), North America Nonmember: other (virtual participation), global Industry AttendanceWhile we encourage in-person attendance, we are providing the virtual option for those who cannot travel to the meeting. I will travel to Madison I will participate virtually I am a: Rheumatology Fellow Postdoctoral Fellow Resident Medical Student Other Student I am a: Rheumatology Fellow Postdoctoral Fellow Resident Medical Student Advanced practice provider (PA, NP) Research coordinator Trainee Symposium - Thursday, April 28*Trainees may participate in the 2022 SPARTAN Annual Meeting in one of three ways (see options below). We encourage SPARTAN trainee members and all nonmember trainees with a research interest in spondyloarthritis to meet us in Madison but are providing virtual access for those unable to travel. SPARTAN will reimburse all attendees for travel, up to 3 nights in the conference hotel, and (trainees only) up to $100 for ground transportation and parking. In-person attendance at the Trainee Symposium and Scientific Meeting in Madison In-person attendace at the Trainee Symposium only Virtual attendance at the Trainee Symposium only Virtual attendance at the Trainee Symposium and Scientific Meeting I plan to:* Attend the Trainee Symposium only Attend both the Trainee Symposium and Scientific Meeting Attend the Scientific Meeting only Trainee Symposium - Thursday, April 28*We encourage attendance in Madison but are providing virtual access for those unable to travel. SPARTAN will reimburse all attendees for up to 3 nights in the conference hotel and up to $400 for airfare. In-person attendance at the Trainee Symposium and Scientific Meeting in Madison In-person attendace at the Trainee Symposium only Virtual attendance at the Trainee Symposium only Virtual attendance at the Trainee Symposium and Scientific Meeting Annual Reception - Friday, April 29*We'll gather at the nearby Madison Museum of Contemporary Art for a celebratory dinner. Space is limited and RSVP required. Two representatives per company will be included with others on a waiting list and invited if space permits. Yes, I would like to attend No, I do not plan to attend Annual Reception - Friday, April 29*We'll gather at the nearby Madison Museum of Contemporary Art for a celebratory dinner. Space is limited and RSVP required. Free for trainees. $50 deducted from all other expense reimbursements. Yes, I would like to attend No, I do not plan to attend How did you learn about the SPARTAN Trainee Symposium and Annual Meeting?Human Check: What is 2+3?* Δ
