Resident Banquet Registration | HWSS

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2025 HWSS Symposium
HWSS 2025 Additional Donation
Faculty/Alumni Registration ONLY
- Faculty/Alumni Banquet Registration
Resident Registration ONLY
- Resident Banquet Registration
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Resident Banquet Registration

Resident Level

PGY1

PGY2

PGY3

PGY4

First Name

Last Name

Address, City, State, Zip

Email

Phone

Special Dietary Option:

Vegetarian

Gluten free

Nut free

Dairy Free

Please list any additional food allergies

SCHEDULE OF EVENTS

HWSS Banquet Gala, Friday, June 13 at 6 PM

I will be attending alone

I will be attending with a guest

I will not be attending

Guest Information

Guest First and Last Name for Banquet

Special Dietary Option:

Vegetarian

Gluten free

Nut free

Dairy Free

Please list any additional food allergies

Select event (s) you will attend ($) *

HWSS Resident/ Banquet Gala - $25.00

Guest/Banquet Gala - $25.00

Both - $50.00

Thanks for registering. See you there!

This form no longer accepts submissions.

Contact

Phone

(901) 448-3511

Email

blewis48@uthsc.edu

Hours

Mon - Fri: 7am - 4pm

Address

The University of Tennessee Health Science Center
910 Madison Ave., 2nd Floor | Memphis, TN 38163

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