Preceptor/Sponsor/Student/Exhibitor Registration Form For Preceptors, Presenters not accompanied by a Preceptor, representatives from a sponsoring company and students. (All of the following fields are required.  Please enter N/A if any required answers are not applicable.  For example, you would enter N/A for middle initial if you did not have a middle name.) If you are a presenting resident or fellow, please click here to register. Last Name:     First Name:     Middle Initial:     Institution:     Street Address of Institution:     City:     State:     Business Phone:     Email Address:     REGISTRATION TYPE / FEE: (See below for registration payment information.)   Preceptor Registration $200 Pharmacy Students (does not include Lunch or Evening functions) $50 Industry Sponsor Registration (No Charge) Exhibitor Registration $100 (for conference attendance) Exhibitor Booth Rental (see Exhibitor Registration Form - PDF)     PAYMENT INFORMATION: Make Checks Payable to: Midwest Pharmacy Residents Conference Mail a copy of your registration form and payment to: Dana J. Lambert Office Coordinator, Pharmacy/Pathology Services THE NEBRASKA MEDICAL CENTER 988485 Nebraska Medical Center Omaha, NE 68198-8485 Phone: 402-559-4412 Fax: 402-559-4741 Email:   HOTEL ACCOMMODATIONS AT THE CONFERENCE: For preceptors, presenters not accompanied by a preceptor, presenters from outside the Midwest region, representatives from sponsoring companies and students. You are responsible for making your own hotel arrangements. The Embassy Suites Hotel has rooms available at conference rates. Call the hotel at (402) 346-9000 for reservations. Indicate that you are with the conference when calling for accommodations. Reservations should be made by March 28th.   TRAVELING TO THE CONFERENCE: You are responsible for making your own travel arrangements. There is NO travel reimbursement from the Midwest Pharmacy Residents Conference for anyone other than presenting Residents/Fellows accompanied by a preceptor. Please see the traveling information page for further information.