Edit Attendee

Registration Type

Student Subsidy Application & Instructions

The AMEN board generously offers a subsidy to currently enrolled medical and dental students (& their spouse) to attend the AMEN annual conference in Myrtle Beach, SC October 27 – 30, 2022. The board is committed to mentoring young physicians and dentists so they can begin their careers not only as medical professionals but as true medical evangelists right from the beginning. For more information and a list of requirements, please go to: amensda.org/conference/student-subsidy

Attendee *

PARTIAL REGISTRATION

Partial registration begins with supper on Friday night and includes all meals and meetings for the rest of the weekend. - It does NOT include the seminars Friday afternoon.

Discounts

I am a medical, dental or optometry resident

I am a pastor

Please list any medical conditions, food allergies, etc.

50% off

Name of Residency Program *

Year of Completion *

Exhibitor *

Exhibitor - $750

Add-on Exhibit Space

Add-on Space - $225

Will items be sold/promoted at your booth? *

Yes

No

Please describe/list items to be promoted and/or sold. *

Summarizing is acceptable for written materials. For example: 'Books fitting the mission of AMEN published by Pacific Press' or Glad Tidings Publishers would be sufficient for those organizations.

Addons

Electricity for Exhibit Space - Free for regular use

Child Care

Child Care ($10)

Childcare Friday afternoon during the seminars (2-5:30pm)

Registration Deposit Method *

Credit Card

Check

Your refundable $100 deposit may be made by mailing a check to
AMEN
PO Box 2528
Greeneville, TN 37744
Please write STUDENT ATTENDEE DEPOSIT on the memo line of the check so your check will not be cashed. Checks will be destroyed and PayPal deposits refunded by November 15, 2022 UNLESS you do not show up or if you cancel AFTER October 16, 2022.

Agreement

By submitting this subsidy, I confirm that I want to attend the AMEN conference to learn how to share Christ through medical evangelism and I will attend the meetings. I am also willing to sign up to volunteer while I am at the conference (such as usher, musician, meal ticket scanner, etc).

Medical/dental school *

Area of Study *

Graduation Year *

Arrival Date *

Departure Date *

Roommate Type * Roommate Type

Gender *

Spouse Name

I confirm that my spouse and I are already married *

Yes

Please list your approximate annual income

Convert to dollars if possible, or list the currency and we will convert it.

1. Please state your reasons for why you need a subsidy to attend the AMEN conference. Please include your reasons for wanting to attend the conference, your professional background, and plans for how you hope to further the mission of AMEN. *

2. Please attach a letter of good standing from your church pastor (letter must be on church letterhead) *

Maximum upload size: 268.44MB

3. Please note, we do not pay for airfare to attend the conference. Also, the subsidy granted may only be for a portion of the total conference cost, and not the full amount. *

I accept the conditions

Total

Discount Code

First Name *

Last Name *

Degree

not required

City *

State * State

Select other for international

Cell Phone *

Email *

Specialty

Age *

Continuing Education

CME Credits - $50

CDE Credits - $50

CME Credits - $60

CDE Credits - $60

CME Credits - $70

CDE Credits - $70

CE - Allied Health Professionals - $50

CE - Allied Health Professionals - $60

CE - Allied Health Professionals - $70

Dental License #

Medical License #

CE License # *

Organization *

Mission *

Goal *

Is this your first AMEN conference? *

Yes

No

I am planning on attending the business meeting on Thursday 10/27 at 5:00pm. *

Yes

No